A Retrospective Study Of The Incidence Of Chronic GVHD Post Hematopoietic Stem Cell Transplantation Based On FBCA Conditioning Regimen

Background:Allogeneic hematopoietic stem cell transplantation(Allo-HSCT)is currently an effective treatment for a variety of hematological tumors,bone marrow failure,hereditary diseases and certain solid tumors.With the development of HLA matching technology,anti-infection and supportive treatment progress,the transplantation effect has been significantly improved,and the long-term total survival of leukemia patients has reached 40%-60%.Among them,graft-versus-host disease(GVHD)is still the main cause of death failure in patients.In particular,chronic GVHD seriously affects the quality of life of patients.The occurrence of GVHD is closely related to HLA matching,graft type,pretreatment regimen,and post-transplant immunosuppressive applications.In the past,according to the Seattle Classic Classification method,chronic GVHD was divided into two basic types:localized and extensive.After 2005,the new NIH classification was used,and the affected organs and affected areas were used as the basis for evaluation.The transplant center established the FBCA preconditioning program in 2003,and the incidence of acute GVHD was significantly reduced.According to the Seattle classification method,the incidence of localized chronic GVHD was low.The NIH classification method was used to retrospectively analyze the incidence and seriousness ofchronic GVHD using the FBCA protocol after myeloablative transplantation.Objective:This article mainly discusses the incidence of chronic GVHD after hematopoietic stem cell transplantation in 105 patients with benign and malignant hematological tumors in this transplant center with FBCA preconditioning regimen(Flu+BuCy+ATG),and the new progress in the diagnosis and treatment of chronic GVHD..Methods:The clinical data of 105 patients with benign and malignant hematological tumors who underwent allogeneic hematopoietic stem cell transplantation at the transplant center from January 2013 to December 2017 were retrospectively analyzed.Among them,84 patients with malignant hematological disease and 21 patients with other blood diseases;according to the classification of malignant hematological diseases,the number of moderate-risk cases was 35,and the number of high-risk patients was 48.High-resolution DNA detection by donors and recipients,51 cases of HLA total coincidence,and 54 cases of non-HLA total association.FBCA clear marrow preconditioning program,specifically:Flu 25 mg/m2/d,-9d to-5d,Bu 3.2mg/kg/d,-8d to-5d,Cy 60mg/kg/d,-3d To-d;ATG dose,HLA total binding,1.25 mg/kg/d,-3d to-1d;non-HLA total binding,2.5mg/kg/d,-5d to-1d.The prevention of GVHD is CsA and short-term MTX.The method of CsA is:3mg/kg/d.If there is no GVHD,-1d to +180d to +270d;if GVHD occurs,adjust according to the condition.After the transplantation,the patient was followed up to +180 days.The routine blood,liver and kidney function,bone marrow morphology,MRD monitoring and chimerism were reviewed regularly.All patients were followed up for October 31,2018.Results:The median follow-up of all patients was 21 months(5-63 m).On the 100th day after transplantation,a total of 95 patients survived.According to Seattle standards,the number of chronic GVHD cases was 23,and the total cumulative incidence was 24.21%,of which 17 cases(17.89%)were chronic chronic GVHD.GVHD was 6 cases(6.32%);according to the NIH consensus(2014),the number of chronic GVHD cases was 17 cases,the total cumulative incidence rate was 16.19%,involving 5 cases of skin(4.76%)and 3 cases of eyes(2.86%).),5 cases of digestive tract(4.76%),7 cases of liver(6.67%),2 cases of lung(1.90%),and 1 case of female external genitalia(0.95%).The 1-year OS was 69.3%,the 2-year OS was 52.9%,and the 3-year OS was 47.6%.The 1-year DFS was 67.3%,the 2-year DFS was 47.1%,and the 3-year DFS was 42.4%.During the follow-up period,29 of(27.62%)patients had recurrence with a total mortality rate of 35.24%.The 1-year NRM was 30.74%,and the 2-year NRM was 40.00%.By the end of follow-up,the NRM was 45.95%.Among them,recurrence and infection were the main causes of death in patients in this study.Conclusion:The incidence of chronic GVHD was lower after HSCT in FBCA preconditioning regimen.There was no significant difference in OS,DFS and NRM.The incidence of chronic GVHD was similar under two different diagnostic criteria.The NIH diagnostic criteria were more realistic and objective,and were consistent with clinical use.