摘要
目的本文研究单倍型移植能否改善难治复发儿童白血病的预后。方法抽取2015年8月至2019年8月对33例连续发病的难治复发儿童急性白血病进行单倍型移植,病例是连续发生无选择的病人,使用未经处理重组人粒细胞集落刺激因子(G-CSF)动员后的骨髓联合外周干细胞移植。33例儿童急性白血病中包括急性髓性白血病、急性淋巴细胞白血病两种类型,急性儿童白血病症包括难治型、复发型、二次移植型与未缓解型,存在父母供者、子女供者、兄妹供者。HLA抗原中存在5/10相合、6/10相合与7/10相合。病患年龄跨度较大,同时所有病人均使用加强的清髓性预处理方案。结果移植后+30天骨髓100%完全缓解,嵌合率100%供者型,预处理期间无药物毒性相关死亡(TRM)。急性GVHD-III度、急性GVHD-II度、急性GVHD-I度分别存在3/33、1/33、7/33。而慢性类型中GVHD-广泛性、GVHD-局限性分别为7/33、14/33(42.4%)。移植相关死亡共计2/33例,包括死于复发和GVHD皆有1例。总体存活率93.9%。无病生存随访中位时间13个月(范围6-36个月)。结论单倍型造血干细胞移植对难治复发儿童急性白血病取得高治愈率,低重症GVHD发生率,移植相关死亡率低与无病生存的结果令人鼓舞。
Objective To study whether haplotype transplantation can improve prognosis of refractory and relapsed leukemia of children.Methods We chose 33 cases of consecutive children with refractory and relapsed acute leukemia for haplotype transplantation without selection,from Aug 2015 to Aug 2019.Treat them with bone marrow mobilized with untreated recombinant human granulocyte colony stimulating factor(G-CSF)combined with peripheral stem cell transplantation.Acute leukemia of 33 children included two types of acute myeloid leukemia and acute lymphoblastic leukemia,with refractory type,relapse type,secondary transplantation type and unresponsive type,and donors.of parents,children and sibling.There was 5/10,6/10 and 7/10 coincidence in HLA antigen.Patients had a long age span and all cases were treated with enhanced myeloablative preconditioning.Results After+30 days of transplantation,bone marrow was 100%relieved,chimerism rate was 100%against donor type,there was no drug toxicity related death(TRM)during pretreatment.Acute GVHD-III,acute GVHD-I and acute GVHD-I were 3/33,1/33 and 7/33 respectively.However,in chronic type,GVHD universality and GVHD limitation was 7/33 and 14/33(42.4%)respectively.There were 2/33 transplant related deaths,including 1 case of recurrence and GVHD,with overall survival rate of 93.9%.Median follow-up time for disease-free survival was 13 months(range,6-36 months).Conclusion Haplotype hematopoietic stem cell transplantation can achieve high cure rate,low incidence of severe GVHD,low transplantation related mortality and disease-free survival in refractory and relapsed children with acute leukemia.
作者
魏志杰
Wei Zhi-jie(Department of Transplantation,Yanda Ludaopei Hospital,Langfang,Hebei 065201)
出处
《智慧健康》
2020年第30期37-39,130,共4页
Smart Healthcare
关键词
单倍型移植
难治复发
儿童急性白血病
Haplotype transplantation
Refractory relapse
Children with acute leukemia
