异基因造血干细胞移植治疗儿童高危急性髓系白血病28例疗效分析  

Outcome of allogeneic hematopoietic stem cell transplantation for children with high-risk acute myeloid leukemia

作　　者：江华[1] 缪艳 陈静[1] 罗长缨[1] 王坚敏 

机构地区：[1]上海交通大学医学院附属上海儿童医学中心血液肿瘤科,上海200127

出　　处：《中国实用儿科杂志》2013年第8期601-605,共5页Chinese Journal of Practical Pediatrics

摘　　要：目的分析异基因造血干细胞移植(Allo-HSCT)治疗儿童高危急性髓系白血病(AML)临床疗效,寻找可能的影响预后的因素。方法回顾性分析2001年4月至2011年1月在上海交通大学医学院附属上海儿童医学中心接受异基因造血干细胞移植治疗的高危AML患儿28例的长期随访资料。结果28例患者中12例死亡,其中9例复发,1例移植后严重感染,1例移植后严重肝静脉闭塞综合征(VOD)、多器官功能衰竭,1例严重肺部慢性移植物抗宿主病(cGVHD),复发患者占死亡病例数的75.0%(9/12);总3年无病存活率(DFS)为(56.4±9.5)%。移植时疾病为第一次缓解(CR1)患者与第二次缓解(CR2)患者3年DFS分别为(70.7±12.4)%和(42.9±13.2)%,差异无统计学意义(P=0.106)。CR2组中大年龄(≥10岁)患者预后明显差于小年龄(<10岁)患者,3年DFS分别为0和(60.0±15.5)%(P=0.03),CR2组中4例大年龄患者全部在移植后2年内死亡。CR1组中≥10岁患者和<10岁患者3年DFS分别为(66.7±19.2)%和(75.0±15.3)%,差异无统计学意义(P=0.163)。结论Allo-HSCT治疗能有效改善高危AML患儿预后,复发仍是移植失败的最主要原因;对于临床高危AML患者,特别是大年龄者,应在具有合适供体情况下,在合适时机优先选择移植治疗,以尽量减少在CR2时即使接受移植后仍面临的高复发风险。Objective The clinica! efficacy of allogeneic hematopoietic stem cell transplantation （Allo-HSCT）for chil- dren with high-risk acute myeloid leukemia （AML）has been analyzed to define the possible prognosis factor. Methods We retrospectively reviewed outcomes of 28 children with high-risk AML who underwent allo-HSCT at our hospital be- tween April of 2001 and January of 2011. Results Up to follow-up end point, of 28 cases 12 died, including 9 died of relapse, 1 for severe infection, 1 for severe veno-occlusive disease （VOD）and multiple organ dysfunction （MODS）and 1 for severe lung chronic graft-versus-host disease （cGVHD） ;75% （9/12） patients relapsed in those who finally died. The ctisease-free survival （DFS）of all patients was （56.4 ± 9.5 ）%. The 3 years DFS was not significantly different between patients at first complete remission （CR1）when receiving allo-HSCT and those who at second remission （CR2）（70.7 ± 12.4）% and（42.9 ±13.2）% respectively （P = 0.106）.But in CR2, the eases aged 10 or more had inferior survival com- pared with those younger, 3-DFS being 0% and （60.0± 15.5 ）%, respectively （P = 0.03 ） ;all 4 older cases died within 2 years after HSCT. While 3 DFS was not different between old and young in CR1,3-DFS was （66.7 ±19.2）% and （75.0 ± 15.3）% respectively（P = 0.163）. Conclusion Allo-HSCT is a curative therapy for those children with high-risk AML; relapse is the major cause of treatment failure after allo-HSCT for those AML. For high-risk AML children in CR1, espe- cially for older patients, allo-HSCT should be preferentially considered to prevent from higher relapse risk after HSCT in CR2.

关 键 词：急性髓细胞性白血病 儿童 异基因造血干细胞移植 复发 移植物抗宿主病 

分 类 号：R72[医药卫生—儿科]