自 2005 年以来，Fred Hutchinson 癌症中心 (FHCC) 的慢性移植物抗宿主病 (cGVHD) 发病率稳步下降。为了更好地理解这一现象，我们研究了 2005 年至 2019 年 3066 名幸存者中需要全身免疫抑制 (cGVHD-IS) 的 cGVHD 风险，作为造血细胞移植 (HCT) 日期的函数。Cox 回归模型适合评估 HCT 的关联-使用未调整和调整后的模型，确定 cGVHD 特定原因危害的日期（作为连续线性变量）。研究对象的中位随访时间为 7.0 年（范围，1.0-17.2）。所有幸存者中 cGVHD-IS 的两年概率从 45-52%（2005-2007 年）下降至约 40%（2008-2012 年），然后到 2017 年进一步降至约 26%。分析时也观察到下降。仅限于502名儿科幸存者，自2013年以来，cGVHD-IS概率<10%。在305名因非恶性疾病接受移植的成人和儿科幸存者中，cGVHD发生率波动较大，但2016年后仍保持<20%。每5年增加一次HCT 日期与 cGVHD 病因特异性风险降低 27% 相关（未经调整的风险比 [HR] 0.73；95% 置信区间 [CI] 0.68-0.78，p<.0001）；即使在调整了可能导致cGVHD 减少。 cGVHD 的下降并不能完全用人口变化和 HCT 方法的更多使用来解释，这通常与较低的 cGVHD 发生率相关。这一观察结果强调，单队列 cGVHD 预防研究应使用同期而非历史对照进行比较。版权所有 © 2024 美国血液学会。

Since 2005 there has been steady decline in chronic graft-versus-host disease (cGVHD) at Fred Hutchinson Cancer Center (FHCC). To better understand this phenomenon, we studied the risk of cGVHD requiring systemic immunosuppression (cGVHD-IS) as a function of hematopoietic cell transplantation (HCT)-date in 3066 survivors from 2005 through 2019. Cox regression models were fit to assess associations of HCT-date (as a continuous linear variable) with cause-specific hazards of cGVHD, using unadjusted and adjusted models. Median follow-up for study subjects was 7.0 years (range, 1.0-17.2). Two-year probabilities of cGVHD-IS declined among all survivors from 45-52% (2005-2007) to approximately 40% (2008-2012) and then further to ~26% by 2017. A decline was also observed when the analysis was restricted to 502 pediatric survivors, with cGVHD-IS probabilities being <10% since 2013. Among 305 adult and pediatric survivors who were transplanted for nonmalignant diseases, cGVHD rates showed greater fluctuation but remained <20% after 2016. Each 5-year increase in HCT-date was associated with a 27% decrease in the cause-specific hazard of cGVHD (unadjusted hazard ratio [HR] 0.73; 95% confidence interval [CI] 0.68-0.78, p<.0001); the HR was 0.81 (95% CI 0.75-0.87, p<.0001) even after adjusting for various factors (age, donor/stem-cell source, race, sex, conditioning intensity, GVHD prophylaxis, among others) that could lead to cGVHD reduction. The decline in cGVHD was not fully explained by demographic shifts and greater use of HCT approaches generally associated with lower cGVHD rates. This observation underscores that single-cohort cGVHD-prevention studies should use contemporaneous and not historical controls for comparisons.Copyright © 2024 American Society of Hematology.