亲缘单倍型造血干细胞移植治疗儿童急性白血病疗效分析

亲缘单倍型造血干细胞移植治疗儿童急性白血病疗效分析朱光华;秦茂权;王彬;周翾;杨骏;吴润晖;郑胡镛;吴敏媛
【期刊名称】《中国小儿血液与肿瘤杂志》
【年(卷),期】2013(018)004
【摘要】Objective To analyze the therapeutic effect of haploidentical hematopoietic stem cell transplantation (HSCT) for children with acute leukemia.Methods Twenty-three patients undergone the HSCT in Beijing Children' s Hospital from Jan 2006 to Dec 2011 were analyzed retrospectively.Results The male to female ratio was 16:7 with the median age of 8.0 (range 4.0 ～ 13.5) years old.All the donors were HLA-mismatched parents or siblings,including 8 fathers,9 mothers and 6 siblings.Among theml 1 cases were mismatched in3 HLA loci,8 in2 loci,and 3 in1 locus.The transfusion of CD34 + cells were 10.59 × 106/kg with the median of 8.9 (2.90 ～39.44).The average transfusion cell numbers of MNC were 16.58 × 108/kg (6.06 ～ 27.49).All patients achieved stable engraftments,among which,20 cases (87％) occurred acute graft-versus-host disease (aGVHD) in grade Ⅰ ～Ⅱ and 3 cases (13％) occurred aGVHD in grade Ⅲ ～Ⅳ.The cumulative i ncidence of chronic GVHD was 59％(13/23).The median follow-up time was 896 days (62-2443) after transplantation.Among all cases,12 patients survived with a 5-year overall survival (OS) rate of 52.2％ ; 11 patients died,including 5 cases died of leukemia relapse and 6 cases died of transplantation related
complications.The types of leukemia,gender,age,the status before the transplantation,conditioning regimen and aGVHD had no impact on the survival rate except the disease relapse.Conclusions The survival rate of HSCT for children with acute leukemia has improved to more than 50％
with lower relapse rate and mild GVHD.Although the multivariate analysis showed the disease relapse as the main influencing factor,GVDH may be the potential factor,which should be studied further by collecting more clinical cases.%目的评价单倍型造血干细胞移植(haplo-HSCT)治疗儿童急性白血病(AL)的疗效.方法收集自2006年1月-2011年12月在我院移植病房进行的亲
缘haplo-HSCT治疗儿童AL共23例,总结临床特征,观察haplo-HSCT后植入情况、无病及总体生存率、白血病复发及相关并发症,分析影响生存率的因素.结果 23例AL患儿中,男16例,女7例,中位年龄8.0(4.0 ～13.5)岁.供者中父亲8例,母亲9例,兄弟姐妹6例,HLA配型3/6相合11例,4/6相合8例,5/6相合3例,6/6相合1例(来自患儿母亲).回输CD34+细胞平均数10.59(2.90 ～39.44)× 106/kg,回输MNC平均数16.58 (6.06～27.49)×108/kg.所有患儿均获得完全植入.急性移植物抗宿主病(GVHD)Ⅰ o～Ⅱ° 20例,占87％;Ⅲ°～Ⅳ° 3例,占13％;慢性GVHD发生率59％(13/23).中位随访时间896(62-2443)d.死亡病例中5例为白血病复发,6例死于移植相关并发症,12例无病存活.5年总生存率52.2％.复发率21.7％.仅复发为影响生存率的因素,与白血病类型、病人性别、年龄、移植前状态,预处理方案、aGVHD之间差异均无显著性.结论haplo-HSCT治疗儿童AL总生存率可达到50％以上,复发率相对较低,GVHD以轻度为主,重度GVHD可控制理想.多因素分析影响生存率的主要原因为原发病复发,但是GVHD仍是可能影响因素,由于病例数较少,
需要扩大样本量再评估.
【总页数】5页(P156-160)
【作者】朱光华;秦茂权;王彬;周翾;杨骏;吴润晖;郑胡镛;吴敏媛
【作者单位】100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心;100045 北京,首都医科大学附属北京儿童医院血液病中心
【正文语种】中文
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