The Clinical Analysis Of Characteristic And Therapy Of Acute Graft-versus-host Disease After Related Allogenic Hematopoietic Stem Cell Transplantation

Objective: To report occurrence characteristics of acute graft-versus-host disease after allogeneic peripheral blood stem cell transplantation, evaluate the efficacy of methylprednisolone + cyclosporine A, or in combination with other drug treatment programs in different grade, location of acute graft-versus-host disease. Methods: Analysis the complications of 140 patients with allo-PBSCT, include 78 HLA sibling- matched patients and 62 HLA sibling haploid-matched patients. Using CsA+ MMF+MTX+ glucocorticoid to prevent GVHD for HLA sibling-matched patients; add anti-thymocyte globulin (ATG), CD25 monoclonal antibody, the dose and using time of MMF and glucocorticoid for HLA sibling haploid-matched patients. Acute GVHD (aGVHD) were diagnosed according to the international commonly accepted GVHD diagnostic criteria.Comparing occurrence of aGVHD on time and position in two group. Methylprednisolone +CsA were used as first-line therapy, CD25 monoclonal antibody was used as second line salvage therapy. Results: Under the condition of positive prophylaxis, 35.0% patients were diagnosed as with aGVHD, gradeⅢ～ⅣaGVHD developed in 7.14% patients. 21.8% patients developed aGVHD in sibling-matched group compared with 51.6% patients in sibling haploid-matched group. 83.93% patients showed response to Methylprednisolone +CsA therapy include 62.5% complete response and 21.43% partial response. Responses occurred with skin disease ,liver disease and gastrointestinal disease show no differences. GradeⅠ～ⅡaGVHD show better response than GradeⅢ～Ⅳ. More than 50% patients showed response to CD25 monoclonal antibody who resistant to Methylprednisolone +CsA. Conclusion: Positive prophylaxis decrease the occurrence of aGVHD. More patients developed gradeⅠ～ⅡaGVHD in sibling haploid-matched group,but gradeⅠ～ⅡaGVHD showed no difference in two group. Methylprednisolone +CsA therapy is effective for single organ involved aGVHD. CD25 monoclonal antibody is efficient for who resistant to Methylprednisolone +CsA.