| Abstract | Akutna bolest presatka protiv primatelja predstavlja imunološku reakciju imunokompetentnih stanica presatka protiv imunološki nepodudarnih tkiva primatelja, u primatelju koji zbog imunosupresije ne može odbaciti presadak te je jedna od ranih komplikacija alogene transplantacije hematopoetskih matičnih stanica. Incidencija, vrijeme javljanja i težina simptoma varira ovisno o brojnim obilježjima primatelja i donora. Cilj ovog rada bio je istražiti povezanost incidencije aGvHD s obilježjima presatka i primatelja, te prikazati kliničke karakteristike pacijenata oboljelih od aGvHD u KBC-u Zagreb. Uključeno je 78 pacijenata oboljelih od hematoloških bolesti, liječenih alogenom transplantacijom hematopoetskih matičnih stanica ili infuzijom donorskih limfocita, u sustavu Kliničkog bolničkog centra Zagreb tijekom 2018.godine. Akutni GvHD razvilo je 44,9% ispitanika, većina u četvrtom post-transplantacijskom tjednu, pri čemu je on bio stadija II ili višeg kod 34,6% od ukupnog broja ispitanika. Evidentirana je viša incidencija u pri presatku izoliranom iz periferne krvi (p=0,011) i kod nesrodnih podudarnih donora (p=0,039), dok razlika u incidenciji nije pronađena s obzirom na dob ni intenzitet kondicioniranja. Najveći broj pacijenata (82,9%) imao je kožni oblik bolesti, rjeđe gastrointestinalni (45,7%), a zahvaćenost jetre zabilježena je u samo 8,6% oboljelih. Blagi i srednje teški stadij, s proporcijom preživljenja 100%, zabilježen je u 22,9% i 34,3% pacijenata, dok je udio pacijenata u teškom i životno-ugrožavajućem stadiju, s lošijim preživljenjem, bio ukupno 42,9%. Kumulativna proporcija jednogodišnjeg preživljenja za pacijente oboljele od aGvHD iznosila je 77,1%, a za one bez aGvHD 62,7%, međutim prema Cox-Mantel analizi razlika distribucije nije značajna (p=0.182). Težina kliničke slike nije korelirala ni s dobi pacijenta, danom razvoja ni prelaskom u kronični GvHD, koji se konačno razvio u 20,0% oboljelih. Ispitanici koji su razvili relaps nisu se razlikovali od onih koji nisu u incidenciji aGvHD, no oni koji su preboljeli aGvHD odgodili su pojavu relapsa (p=0,027). S obzirom na viši udio pacijenata s teškim i životno-ugrožavajućim oblicima te nešto nižu ukupnu stopu preživljenja od očekivane, posebna se pažnja treba posvetiti upravo prevenciji tih oblika, a s ciljem povećanja preživljenja. |
| Abstract (english) | Acute graft versus host disease represents the immune response of graft immunocompetent cells against host tissue in immunosuppresed host who is unable to reject the graft and is one of the early complications of allogeneic hematopoietic cell transplantation. Incidence, time of onset and severity of symptoms vary depending on many host and donor features.
The aim of this paper was to explore connection of aGvHD incidence to graft and donor features, and to present clinical characteristics of patients with aGvHD in KBC Zagreb. The study included 78 patients treated for haematological diseases with allogeneic haematopoietic stem cell transplantation or donor lymphocyte infusion in KBC Zagreb during year 2018.
Acute GvHD developed in 44.9% of patients, in most cases during fourth post-transplantation week, and it was grade II or higher in 34.6% of the total number of participants. Higher incidence was noted in patients who received graft isolated from peripheral blood (p=0.011) and from the unrelated matched donor (p=0.039), while no difference was found depending on host age or conditioning intensity. Most common clinical manifestation was skin GvHD affecting 82.9% of patients, gastrointestinal form followed with 45.7%, while liver involvement was noted in only 8.6% of patients. Mild and moderate grade, with a survival proportion of 100%, was marked in 22,9% and 34,3% of patients, while portion of patients with severe and life-threatening grade, with lower survival proportion, was 42,9% in total. Cumulative one-year survival proportion of patients with aGvHD was 77.1%, and for those without 62.7%, but the Cox-Mantel analysis showed no significant difference (p=0.182). Severity of symptoms did not correlate with host age, day of onset nor development of chronic GvHD, which was observed in 20.0% of patients with acute form. Patients who developed relapse did not vary in aGvHD incidence from those who did not develop relapse, but those with aGvHD delayed developing relapse (p=0.027). Considering higher number of patients with severe and life-threatening form of GvHD and modestly lower cumulative survival than expected, special attention is required for prevention of this form with the intention to increase survival. |
