Objective: To explore the influence of relapse and survival by chronic graft versus host disease (cGVHD) in patients with acute myeloid leukemia (AML) after allogeneic hematopoietics stem cell transplantation (allo-HSCT).
Methods: Fifty-five AML patients received allo-HSCT were retrospectively reviewed. Relapse rate and overall survival (OS) were analyzed according to cGVHD.
Results: cGVHD significantly decreased the relapse rate of AML patients after transplantation within 2 years when compared with those without cGVHD (8.7% vs 38.6%, P=0.019), however, cGVHD had no effect on the long-term relapse rate (22.8% vs 5.9%, P=0.217). cGVHD had no effect on OS within 2 years (78.3% vs 61.0%, P=0.155) but could decrease the rate of long-term survival (63.7% vs 100%,P=0.01). cGVHD also could reduce the rate of relapse (8.3% vs 46.2%, P=0.044) and enhanced the rate of survival (83.3% vs 47.2%, P=0.045) in patients with high risk AML after allo-HSCT in 2 years, while it had no effect on the relapse rate and OS in patients with low and intermediated risk AML in early and late phase. Moreover, compared with the rate of relapse(38.6%) in patients without cGVHD, the rate of relapse were lower in patients with limited cGVHD and intensive cGVHD (27.3% and 31.3%, respectively) but the long-term survival was significantly lower (53.3%, P=0.001) in those patients with intensive cGVHD after all-HSCT.
Conclusion: The benefit effect of cGVHD mainly took place within 2 years after allo-HSCT in AML patients especially in those with high risk, while in late phase after allo-HSCT, cGVHD especially intensive cGVHD had an effect on reducing long-term survival.
目的: 探讨慢性移植物抗宿主病(cGVHD)对造血干细胞移植(HSCT)后急性髓系白血病(AML)患者复发及生存的影响。
方法: 回顾性分析接受异基因外周血HSCT的55例发生cGVHD及未发生cGVHD的AML患者复发及生存情况。
结果: cGVHD组移植后2年内的AML复发率显著低于未发生cGVHD组（8.7%对38.6%，P=0.019），而2年后远期复发率与对照组比较差异无统计学意义（22.8%对5.9%，P=0.217）；移植后2年内的生存率差异无统计学意义（78.3%、61.0%，P=0.155），远期生存率cGVHD组明显降低（63.7%对100%，P=0.011）。在难治复发的高危AML患者中，cGVHD组与未发生cGVHD组比较，移植后2年内AML复发率低（8.3%对46.2%，P=0.044），生存率高（83.3%对47.2%，P=0.045）；在中低危AML患者中，有或无cGVHD其复发率及生存率均无显著变化(P=0.266，P =0.289）。局限型及广泛型cGVHD患者中，移植后复发率分别为27.3%和31.3%，较未发生cGVHD患者复发率(42.2%)均下降；但广泛型cGVHD患者远期生存率降低（53.3%，P=0.001）。
结论: cGVHD降低AML复发的保护作用主要发生在移植后早期（2年），尤其使得难治复发的高危AML患者受益；而在移植晚期，cGVHD尤其广泛型cGVHD与移植相关死亡率相关，明显降低远期生存率。