Ringdén O, Labopin M, Gluckman E, Reiffers J, Vernant J P, Jouet J P, Harrousseau J L, Fiere D, Bacigalupo A, Frassoni F, Gorin N C
Department of Clinical Immunology, Huddinge Hospital, Stockholm, Sweden.
Bone Marrow Transplant. 1996 Nov;18(5):921-9.
A total of 1634 recipients of HLA-identical sibling bone marrow with acute leukemia were treated with the combination of cyclosporin A (CsA) and methotrexate as prophylaxis against graft-versus-host disease (GVHD). The probability of relapse decreased with an increasing grade of acute GVHD, especially in patients grafted in first remission (CR-1): P < 0.01 and P < 0.001 for acute lymphoblastic leukemia and acute myeloid leukemia, respectively. Among patients surviving at least 3 months without a relapse, chronic GVHD was associated with a decreased incidence of relapse in CR-1 (P < 0.0001 for both diagnoses), and a better LFS. Among patients in CR-1, the probability of relapse was the same in those with limited or with extensive chronic GVHD. However, in patients with intermediate stage of the disease (> or = 2nd remission or 1st relapse) with previous acute GVHD, those with extensive chronic GVHD had a reduced probability of relapse (P = 0.05). The graft-versus-leukemia effect of acute and especially chronic GVHD was confirmed by multivariate analyses. Overall, the highest LFS was seen in patients with chronic GVHD and no or grades I-II acute GVHD. The lowest LFS was seen in patients having acute GVHD grades III-IV without chronic GVHD.
共有1634例急性白血病患者接受了人类白细胞抗原（HLA）相合的同胞骨髓移植，并采用环孢素A（CsA）和甲氨蝶呤联合方案预防移植物抗宿主病（GVHD）。急性GVHD程度越高，复发概率越低，尤其是处于首次缓解期（CR-1）接受移植的患者：急性淋巴细胞白血病和急性髓细胞白血病患者的复发概率分别为P < 0.01和P < 0.001。在无复发存活至少3个月的患者中，慢性GVHD与CR-1患者复发率降低相关（两种诊断的P值均< 0.0001），且无病生存期（LFS）更好。在CR-1患者中，局限性或广泛性慢性GVHD患者的复发概率相同。然而，在疾病处于中间阶段（≥第二次缓解期或首次复发）且既往有急性GVHD的患者中，广泛性慢性GVHD患者的复发概率降低（P = 0.05）。多因素分析证实了急性GVHD尤其是慢性GVHD的移植物抗白血病效应。总体而言，慢性GVHD且无急性GVHD或急性GVHD为I-II级的患者LFS最高。无慢性GVHD且急性GVHD为III-IV级的患者LFS最低。
