Carlens S, Ringdén O, Remberger M, Lönnqvist B, Hägglund H, Klaesson S, Mattsson J, Svahn B M, Winiarski J, Ljungman P, Aschan J
Department of Clinical Immunology, Huddinge Hospital, Sweden.
Bone Marrow Transplant. 1998 Oct;22(8):755-61. doi: 10.1038/sj.bmt.1701423.
Among 551 consecutive recipients of allogeneic bone marrow transplants, 451 survived more than 3 months and were evaluated for chronic graft-versus-host disease (GVHD). Most of the donors were HLA-identical siblings or parents (n = 334). Patients with HLA-mismatched donors (n = 30) and matched unrelated donors (MUD) (n = 87) were also included in the study. In the analysis of all patients, the 5-year cumulative incidence of chronic GVHD was 45%. We analysed 34 risk factors. High recipient age was the single most important risk factor (P < 0.001). Other significant risk factors in multivariate analysis were: acute GVHD grades I-IV (P < 0.001), immune female donor to male recipient (P = 0.006) and chronic myelogenous leukaemia (CML), compared with all other diagnoses (P = 0.014). The cumulative 5-year incidence of chronic GVHD, with no significant risk factors present, was 9%, 29% with one risk factor, 53% with two, 68% with three and 75% with all four risk factors present. In patients with HLA-identical sibling donors and GVHD prophylaxis consisting of a combination of methotrexate (MTX) and cyclosporin A (CsA) (n = 208), increasing recipient age (P < 0.001) and CML (P = 0.007), were found to be significant risk factors for chronic GVHD. Finally, a multivariate analysis in recipients of bone marrow from unrelated donors (n = 89) showed recipient age alone (P = 0.006) to be significantly associated with chronic GVHD.
在551例接受异基因骨髓移植的连续患者中，451例存活超过3个月，并接受了慢性移植物抗宿主病（GVHD）评估。大多数供者为HLA配型相同的兄弟姐妹或父母（n = 334）。HLA配型不匹配的供者（n = 30）和配型相合的无关供者（MUD）（n = 87）的患者也纳入了本研究。在对所有患者的分析中，慢性GVHD的5年累积发病率为45%。我们分析了34个风险因素。受者年龄较大是唯一最重要的风险因素（P < 0.001）。多因素分析中的其他显著风险因素为：急性GVHDⅠ-Ⅳ级（P < 0.001）、女性供者对男性受者的免疫（P = 0.006）以及慢性粒细胞白血病（CML），与所有其他诊断相比（P = 0.014）。不存在显著风险因素时，慢性GVHD的5年累积发病率为9%，存在一个风险因素时为29%，两个风险因素时为53%，三个风险因素时为68%，四个风险因素都存在时为75%。在接受HLA配型相同的同胞供者移植且采用甲氨蝶呤（MTX）和环孢素A（CsA）联合预防GVHD的患者中（n = 208），受者年龄增加（P < 0.001）和CML（P = 0.007）被发现是慢性GVHD的显著风险因素。最后，对接受无关供者骨髓移植的患者（n = 89）进行的多因素分析显示，仅受者年龄（P = 0.006）与慢性GVHD显著相关。
