慢性移植物抗宿主病_培训课件.ppt

(A) Overall survival from cGVHD diagnosis for patients with 1–3 versus ≥ 4 organs involved (B) for patients with classic cGVHD versus overlap syndrome and (C) for patients with delayed aGVHD versus classic cGVHD. Cumulative incidence of OS according to NIH global severity at enrollment. Graph shows 2-year survival estimates, 95% confidence intervals (in parentheses), and hazard ratios (HR). Data are from the prospective study of the US cGVHD consortium (N = 298). Reprinted with permission from Arai et al.19 * * pathogenic donor T cells that expand in response to alloantigens or autoantigens unchecked by normal thymic or peripheral mechanisms of deletion Critical donor or recipient tolerance-promoting cells may be absent These pathologic T cells then attack target tissue directly through cytolytic attack, secretion of inflammatory and fibrosing cytokines, or promotion of B-cell activation and autoantibody production. * Acute GVHD prophylaxis regimen does not affect rate of cGVHD Bacigalupo et al, BBMT 2006; 12 In MUD BM transplants ATG prevents extensive cGVHD, chronic lung dysfunction, reduces late TRM and improves QOL Deeg et al, BBMT 2006; 12 In MUD and MRD PBSC transplants ATG reduced incidence of cGVHD w/o affecting relapse-free survival Lu et al, Blood 2006; 107 ATG as part of conditioning in related mismatched donor PBSC/BM transplant vs. no ATG in MRD. Similar incidence of acute and cGVHD among HLA mismatched and MRD; similar incidence in 2 –year TRM and relapse * * 27% of patients referred with “cGVHD” do not have cGVHD. (Jacobsohn et al. 2001.) * * 85% of Pts who survive 5 yrs are able to go off systemic immunosuppression 10-25% of patients will flare after stopping Thalidomide: Koc, Blood 2000; Arora, BBMT 2001 – no clinical benefit MMF: in progress * * Antibiotic prophylaxis (Pen VK) Immunizations IVIG * 内 容 Update of knowledges in cGVHD Progress in pathophysiology of cGVHD Treatment for cGVHD Novel therapeutic strategies of cGVHD cGVHD的病理生理学 T