不同来源的造血干细胞移植治疗230例儿童急性淋巴细胞白血病患者预后的比较  

Comparison of prognosis of 230 children with acute lymphoblastic leukemia treated with hematopoietic stem cell transplantation from different sources

作　　者：杨晨唯 赵夏莹 卢俊[1] 肖佩芳[1] 李捷[1] 李泊涵 程生钦 吴水燕[1] 胡绍燕[1] 凌婧[1] YANG Chenwei;ZHAO Xiaying;LU Jun;XIAO Peifang;LI Jie;LI Bohan;CHENG Shengqin;WU Shuiyan;HU Shaoyan;LING Jing(Department of Pediatrics Hematology and Oncology,Children′s Hospital of Soochow University,Suzhou 215000,China)

机构地区：[1]苏州大学附属儿童医院,苏州215100

出　　处：《中国小儿血液与肿瘤杂志》2024年第2期109-113,共5页Journal of China Pediatric Blood and Cancer

基　　金：科技部国家重点研发计划课题(2022YFC2502701);国家自然基金课题(81970163);江苏省社会发展项目(BE2021654);江苏省自然基金课课题(BK20210097);苏州市课题资助(SZS201615和SKY2022012)。

摘　　要：目的 比较四种造血干细胞来源的移植,即亲缘单倍体HSCT(Haplo-HSCT)、脐血HSCT(UCB-HSCT)、同胞全相合HSCT(MSD-HSCT)和无关全相合HSCT(MUD-HSCT)治疗儿童急性淋巴细胞白血病(ALL)后造血重建以及预后的差异。方法 回顾性分析2012年8月—2022年1月,在苏州大学附属儿童医院接受异基因造血干细胞移植(allo-HSCT)治疗的230例ALL患者的临床资料,分别比较不同移植方式患者移植后造血重建的差异,预后特征及预后的影响因素。结果 230例患者中,228例获得中性粒细胞植入,植入时间为13(9-33)d, 208例血小板植入成功,植入时间为16(3-93)d。接受UCB-HSCT的患者的中性粒细胞植入时间为16(10-33)d,血小板植入时间为34(15-93)d,均显著长于其他移植方式(P<0.05)。接受UCB-HSCT的患者血小板植入率为76%,显著低于其他移植方式(P<0.05)。接受Haplo-HSCT、UCB-HSCT、MSD-HSCT和MUD-HSCT的患者5年总生存率(OS)分别为75.6%、68%、70.6%和75%,差异均无统计学意义(P>0.05)。接受Haplo-HSCT、UCB-HSCT和MUD-HSCT的患者累计复发率(RR)没有显著差异(P>0.05),接受MSD-HSCT的患者累计RR显著高于其他三种移植方式(P<0.05)。结论 UCB-HSCT虽然造血重建时间和造血重建率显著低于其他移植方式,但是总体预后没有明显差异。Haplo-HSCT治疗ALL的疗效不劣于MSD-HSCT和MUD-HSCT,UCB-HSCT和Haplo-HSCT可作为ALL重要的替代供者。Objective To compare the differences of hematopoietic reconstitution and prognosis between Haplo-HSCT,UCB-HSCT,MDS-HSCT and MUD-HSCT in acute lymphoblastic leukemia(ALL)pediatric patients.Methods The clinical data of 230 ALL pediatric patients who underwent allo-HSCT from August 2012 to January 2022 in the children′s Hospital of Soochow University were included.The differences of hematopoietic reconstitution,prognostic characteristics and prognostic factors were analyzed retrospectively.Results Of the 230 patients,228 patients had achieved neutrophil engraftment for 13(9-33)days,and 208 patients had successful platelet engraftment for 16(3-93)days.The neutrophil engraftment time of UCB-HSCT was 16(10-33)days and the platelet engraftment time of UCB-HSCT was 34(15-93)days,both significantly longer than that of other hemopoietic methods(P<0.05).The rate of platelet implantation was 76%,which was significantly lower than that of other hemopoietic methods(P<0.05).The 5-years overall survival rates of Haplo-HSCT,UCB-HSCT,MSD-HSCT and MUD-HSCT were 75.6%,68%,70.6%and 75%respectively,with no significant differences(P>0.05).There was no significant differences in recurrent rate(RR)among Haplo-HSCT,UCB-HSCT and MUD-HSCT(P>0.05),the RR of MSD-HSCT was significantly higher than the other three transplantation methods(P<0.05).Conclusions Although the hematopoietic reconstitution rate and hematopoietic reconstitution time of UCB-HSCT are significantly lower than that of other transplantation methods,there is no significant difference in the overall prognosis.Haplo-HSCT is not inferior to MSD-HSCT and MUD-HSCT in the treatment of ALL,Haplo-HSCT and UCB-HSCT can be used as an important alternative donor.

关 键 词：造血干细胞移植 急性淋巴细胞白血病 造血重建 预后 

分 类 号：R733.71[医药卫生—肿瘤]