PDF(Pubmed)
Abstract：
UNASSIGNED: Chronic graft-versus-host disease (cGvHD) is a serious late complication of allogeneic hematopoietic stem cell transplantation (allo-HSCT).
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.
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.
摘要：
■慢性移植物抗宿主病（cGvHD）是异基因造血干细胞移植（allo-HSCT）的严重晚期并发症。
■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。
■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。
