异基因造血干细胞移植后单独胃肠道受累急性移植物抗宿主病的临床特征

目的 分析异基因造血干细胞移植(allo-HSCT)后患者发生单独累及胃肠道的急性移植物抗宿主病(aGVHD)的临床特征.方法 回顾性总结2007年11月至2008年12月在我院行allo-HSCT治疗的307例血液病患者的临床资料,分析单独胃肠道受累的aGVHD的临床特征、危险因素、治疗效果及预后.结果 307例患者中174例(56.7%)发生aGVHD,其中单独累及胃肠道的38例,占21.8%.单独累及胃肠道的aGVHD的发生与受者性别、年龄、供受者性别关系、供受者血型关系、基础疾病诊断及回输的单个核细胞均无关;但与移植类型相关,亲缘全相合组发生率高于亲缘不合组及非血缘组.单独累及胃肠道的aGVHD患者经糖皮质激素或抗CD25单克隆抗体治疗,仅有2例死于aGVHD未控制合并感染,总有效率达94.7%;发生Ⅱ～Ⅳ度aGVHD但非单独累及胃肠道的患者抗aGVHD治疗总有效率为85.2%;组间比较差异有统计学意义(P=0.015).单独累及胃肠道的aGVHD中有12例应用抗CD25单克隆抗体治疗,治疗均有效.结论 HSCT后单纯累及胃肠道的aGVHD并不少见,其发生率在亲缘全相合组高于亲缘不全相合组及非血缘组,单独累及胃肠道的aGVHD对抗aGVHD治疗效果好,可能与应用抗CD25单克隆抗体疗效较好有关.

Clinical characteristics of acute graft-versus-host disease confined solely to gastrointestinal tract after allogeneic hematopoietic stem cell transplantation

Objective To observe the characteristics of acute graft-versus-host disease (aGVHD) confined solely to gastrointestinal tract after allogeneic hematopoietic stem cell transplantation (allo-HSCT).Methods Clinical data of 307 patients who received allo-HSCT in our hospital between November 2007 and December 2008 were retrospectively analyzed. Clinical features, risk factors, therap(e)utic effects and prognosis of 38 patients whose aGVHD confined solely to gastrointestinal tract after allo-HSCT were analyzed.Results The incidence of aGVHD was 56. 7% (174/307). aGVHD confined solely to gastrointestinal tract occurred in 38 out of 174 patients (21.8%). The incidence of aGVHD confined solely to gastrointestinal tract was affected by human leukocyte antigen (HLA)-compatible level. The patients transplanted from HLA-matched donor had a higher probability of aGVHD confined solely to the gastrointestinal tract. After treatment with glucocorticoids or anti-CD25 monoclonal antibody, 2 patients who had aGVHD confined solely to the gastrointestinal tract died of uncontrolled aGVHD and concurrent infection. The total effective rate was 94.7%. But for patients who had aGVHD between Ⅱ-Ⅳ degree and not confined solely to gastrointestinal,therapeutic effective rate was 85.2%. There was a difference in therapeutic effect between the two groups (P =0. 015). Anti-CD25 monoclonal antibody was used in 12 patients who had aGVHD confined solely to the gastrointestinal tract and all patients' conditions of aGVHD were controlled. Conclusions aGVHD confined solely to gastrointestinal tract after HSCT was not rare. The incidence of aGVHD confined solely to gastrointestinal tract was higher in HLA-matched sibling donor than in mismatched transplantation.Therapeutic efficacy for the aGVHD confined solely to gastrointestinal tract was good. The favorable outcome might be related with the application of anti-CD25 monoclonal antibody.