UNASSIGNED: This multicenter analysis determined the cumulative incidence (CI) of cGvHD and late acute GvHD (laGvHD) and its impact on transplantation-related mortality (TRM), relapse (R), and overall survival (OS) in 317 patients [296 adults, 21 pediatrics (<12 years of age)] who underwent their first allo-HSCT in 2017.
UNASSIGNED: The CI of laGvHD was 10.5% in adults and 4.8% in pediatrics, and the CI of cGvHD was 43.0% in all adult transplant patients and 50.2% in the adult at-risk cohort at the study end. The onset of cGvHD was de novo in 42.0% of patients, quiescent in 52.1%, and progressive in 5.9%. In adults, prophylactic use of antithymocyte globulin or posttransplant cyclophosphamide was associated with a significantly lower incidence of cGvHD (28.7%) vs. standard prophylaxis with calcineurin inhibitors (30.6%) and methotrexate/mycophenolate mofetil (58.4%) (all p < 0.01). TRM was significantly higher in patients with aGvHD (31.8%) vs. cGvHD (12.6%) and no GvHD (6.3%) (all p = 0.0001). OS in the adult at-risk cohort was significantly higher in patients with cGvHD (78.9%) vs. without (66.2%; p = 0.0022; HR 0.48) due to a significantly lower relapse rate (cGvHD: 14.5%; without cGvHD: 27.2%; p = 0.00016, HR 0.41). OS was also significantly higher in patients with mild (80.0%) and moderate (79.2%) cGvHD vs. without cGvHD (66.2%), excluding severe cGvHD (72.7%) (all p = 0.0214).
UNASSIGNED: The negative impact of severe cGvHD on OS suggests a focus on prevention of severe forms is warranted to improve survival and quality of life.
■此多中心分析确定了cGvHD和晚期急性GvHD(laGvHD)的累积发生率(CI)及其对移植相关死亡率(TRM)的影响,复发(R),317例患者的总生存率(OS)[296例成人,21名儿科(<12岁)]在2017年接受了首次allo-HSCT。
■成人laGvHD的TheCI为10.5%,儿科为4.8%,在研究结束时,所有成人移植患者的cGvHDCI为43.0%,在成人高危队列中为50.2%.在42.0%的患者中,cGvHD的发作是从头的,静止在52.1%,进步5.9%。在成年人中,预防性使用抗胸腺细胞球蛋白或移植后环磷酰胺与cGvHD的发生率显着降低(28.7%)。钙调磷酸酶抑制剂(30.6%)和甲氨蝶呤/霉酚酸酯(58.4%)的标准预防(均p<0.01)。aGvHD患者的TRM明显高于(31.8%)。cGvHD(12.6%)和无GvHD(6.3%)(所有p=0.0001)。cGvHD患者的成人高危队列中的OS明显高于(78.9%)。由于复发率显着降低(cGvHD:14.5%;无cGvHD:27.2%;p=0.00016,HR0.41),无(66.2%;p=0.0022;HR0.48)。轻度(80.0%)和中度(79.2%)cGvHD患者的OS也显著高于没有cGvHD(66.2%),不包括重度cGvHD(72.7%)(所有p=0.0214)。
严重cGvHD对OS的负面影响表明,有必要重点预防严重形式,以提高生存率和生活质量。