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目的探讨异基因造血干细胞移植(allo-HSCT)后慢性移植物抗宿主病(cC-VHD)的临床特点、相关危险因素及治疗效果。方法回顾性分析69例allo-HSCT患者的临床资料。根据供、受者的关系以及配型情况,将患者分为三组:A组为亲缘全相合异基因骨髓移植,22例;B组为亲缘全相合异基因外周血干细胞移植,37例;C组为非血缘移植和不全相合移植,10例。术前均采用化疗预处理,术后采用短程甲氨蝶呤联合环孢素A(CsA)预防移植物抗宿主病(GVHD)。局限性cGVHD患者多采用单一免疫抑制剂(CsA或糖皮质激素)治疗,病情进展者采用标准方案(CsA联合糖皮质激素)治疗;广泛性cGVHD患者则需用标准方案治疗(一线治疗方案)。一线治疗无效、病情进展者,对一线治疗依赖不能停药,或停药后病情反复者,需用他克莫司、霉酚酸酯及硫唑嘌呤治疗(二线治疗方案)。结果移植后随访6～120个月,中位时间为43个月,39例诊断为cGVHD,其中局限性cGVHD 13例(33.3%,13/39),广泛性cGVHD 26例(66.7%,26/39),7例死于cGVHD或与之相关的并发症。B组cGVHD发生率较A组显著升高(P<0.05),B组和C组的广泛性cGVHD发生率显著高于A组(P<0.05)。外周血干细胞移植和病程中发生2～4度急性GVHD是cGVHD发生的主要危险因素。局限性cGVHD患者采用一线方案治疗的有效率显著高于广泛性cGVHD患者(P<0.05),标准危险度cGVHD者的治疗有效率显著优于高危险度cGVHD者(P<0.05)。结论cGVHD是allo-HSCT后常见并发症和致死原因;广泛性cGVHD多发生于异基因外周血干细胞移植、HLA配型不全相合移植和非血缘移植,且临床治疗效果不佳。
Objective To investigate the clinical features, related risk factors and therapeutic effects of chronic graft-versus-host disease (cC-VHD) after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Methods The clinical data of 69 patients with allo-HSCT were retrospectively analyzed. The patients were divided into three groups according to the relationship between donors and recipients, as well as the distribution of the patients: group A was matched with allogeneic allogeneic bone marrow transplantation in 22 cases; group B was allogeneic allogeneic peripheral blood stem cell transplantation in 37 cases; C Group of non-blood transplant and incomplete fusion, 10 cases. Chemotherapy was used preoperatively. Short-course methotrexate plus cyclosporine A (CsA) was used to prevent graft-versus-host disease (GVHD). Limitations Most patients with cGVHD are treated with a single immunosuppressive agent (CsA or glucocorticoid) and their disease progression is treated with a standard regimen (CsA plus glucocorticoid). Patients with extensive cGVHD require standard regimens (first-line regimen). First-line treatment is ineffective, the progression of the disease, the first-line treatment can not rely on withdrawal, or after stopping the patient repeatedly, need to use tacrolimus, mycophenolate and azathioprine treatment (second-line treatment). Results The patients were followed up for 6 to 120 months after transplantation. The median time was 43 months and 39 cases were diagnosed as cGVHD. Among them, 13 cases were localized cGVHD (33.3%, 13/39), 26 cases were cGVHD (66.7% 39) and 7 died of or associated with cGVHD. The incidence of cGVHD in group B was significantly higher than that in group A (P <0.05). The incidence of extensive cGVHD in group B and C was significantly higher than that in group A (P <0.05). Peripheral blood stem cell transplantation and 2 to 4 degrees of acute GVHD during the course of disease are the major risk factors of cGVHD. Limitations The first-line regimen of cGVHD patients is significantly more effective than generalized cGVHD patients (p <0.05). The standard-risk cGVHD treatment is significantly better than the high-risk cGVHD patients (p <0.05). Conclusions cGVHD is a common complication and cause of death after allo-HSCT. Extensive cGVHD mostly occurs in allogeneic peripheral blood stem cell transplantation, HLA-matched incompatible transplantation and non-blood transfusion, and its clinical curative effect is poor.