Ringdén O, Hermans J, Labopin M, Apperley J, Gorin N C, Gratwohl A
Dept of Clinical Immunology, Huddinge Hospital, Stockholm, Sweden.
Leuk Lymphoma. 1996 Dec;24(1-2):71-9. doi: 10.3109/10428199609045715.
The purpose of the present study was to evaluate the relation between the grade of acute graft-versus-host disease (GVHD) and several outcome parameters. Special attention was given to leukaemia-free survival (LFS). The study included 2,122 patients with acute leukaemia in first remission and 780 patients with chronic myeloid leukaemia (CML) in the first chronic phase, who were receiving first transplants from HLA-identical donors. Transplant-related mortality (TRM) was the same in patients with or without grade I acute GVHD, but was increased in patients with grades II, III and IV acute GVHD. In patients with grades 0, I, II, III and IV acute GVHD, the five-year probability of TRM (+/-SE) overall was 20 +/- 1%, 19 +/- 2%, 30 +/- 2%, 61 +/- 4% and 90 +/- 3%, respectively. The incidence of relapse in patients with grades I-IV was lower than in patients without acute GVHD. The five-year relapse probability according to GVHD grade (0-IV), was 28 +/- 2%, 22 +/- 2%, 22 +/- 2%, 17 +/- 5% and 20 +/- 2%. The five-year LFS in all patients with leukaemia, according to grade of acute GVHD, was 57 +/- 2%, 63 +/- 2%, 55 +/- 3%, 32 +/- 4% and 8 +/- 3%. In multivariate analysis, adjustments for age, sex, diagnosis, interval from diagnosis to transplantation, T-cell depletion and year of transplantation were considered. Patients with grade I acute GVHD had the highest LFS (relative risk 0.84, p = 0.04 compared with those without acute GVHD).
本研究的目的是评估急性移植物抗宿主病（GVHD）的分级与多个结局参数之间的关系。特别关注无白血病生存期（LFS）。该研究纳入了2122例首次缓解期的急性白血病患者和780例处于慢性期的慢性髓性白血病（CML）患者，他们均接受来自 HLA 配型相同供者的首次移植。有或无 I 级急性 GVHD 的患者移植相关死亡率（TRM）相同，但 II、III 和 IV 级急性 GVHD 患者的 TRM 有所增加。在 0、I、II、III 和 IV 级急性 GVHD 患者中，TRM 的五年总体概率（±标准误）分别为 20±1%、19±2%、30±2%、61±4%和 90±3%。I-IV 级患者的复发率低于无急性 GVHD 的患者。根据 GVHD 分级（0-IV）的五年复发概率分别为 28±2%、22±2%、22±2%、17±5%和 20±2%。根据急性 GVHD 分级，所有白血病患者的五年 LFS 分别为 57±2%、63±2%、55±3%、32±4%和 8±3%。在多变量分析中，考虑了对年龄、性别、诊断、从诊断到移植的间隔时间、T 细胞去除和移植年份进行校正。I 级急性 GVHD 患者的 LFS 最高（与无急性 GVHD 的患者相比，相对风险为 0.84，p = 0.04）。
