儿童血液系统恶性肿瘤患者异基因外周血干细胞移植的长期结局：西班牙儿童血液和骨髓移植工作组（GETMON）及西班牙异基因外周血移植组（GETH）的报告
Long-term outcome of allogeneic PBSC transplantation in pediatric patients with hematological malignancies: a report of the Spanish Working Party for Blood and Marrow Transplantation in Children (GETMON) and the Spanish Group for Allogeneic Peripheral Blood Transplantation (GETH).
作者信息
Diaz M A, Gonzalez-Vicent M, Gonzalez M E, Verdeguer A, Martinez A, Perez-Hurtado M, Badell I, de la Rubia J, Bargay J, de Arriba F, Diez J L, Caballero D, Madero L, Brunet S
机构信息
Department of Pediatrics, Division of Pediatric Hematology Oncology, Hospital Infantil Niño Jesus, Madrid, Spain.
出版信息
Bone Marrow Transplant. 2005 Nov;36(9):781-5. doi: 10.1038/sj.bmt.1705135.
We analyzed the clinical outcome in 90 children undergoing allogeneic PBSC transplantation from HLA-identical relative for leukemia. GvHD prophylaxis was CsA+ methotrexate in 50 and CsA+/-steroids in 40. Median CD34+ cells infused were 6 x 10(6)/kg (range, 1.4-32). Median follow-up was 60 months (range, 6-115). CI of transplant-related mortality (TRM) was 18.4+/-4%. On multivariate analysis, high Lansky score (>80) at transplantation was associated with lower TRM (HR, 0.9; P<0.0002). Relapse incidence (RI) was 33.6+/-6%. On multivariate analysis, high Lansky score at transplantation and cGvHD were associated with lower RI (HR, 0.04; P<0.0005 and HR, 0.23; P<0.03, respectively). Disease-free survival (DFS) was 57.8+/-5%. Disease status at transplantation (HR, 0.33; P<0.02), steroid treatment at day +90 (HR, 5.61; P<0.005) and cGvHD (HR, 0.23; P<0.005) had a significant impact on DFS in multivariate analysis. CI of cGvHD was 63.7+/-7%. Patients with cGvHD had better DFS (65+/-5%) because of lower RI (15.7+/-6%) and similar TRM (27.4+/-4%). These data suggest acceptable long-term outcomes after allogeneic PBSC transplantation in children despite the high incidence of cGvHD. These patients had a lower risk of relapse and a better DFS.
我们分析了90例接受来自 HLA 相同亲属的异基因外周血干细胞移植治疗白血病的儿童的临床结局。50例患者采用环孢素A（CsA）+甲氨蝶呤预防移植物抗宿主病（GvHD），40例采用CsA+/-类固醇。输注的CD34+细胞中位数为6×10⁶/kg（范围1.4 - 32）。中位随访时间为60个月（范围6 - 115）。移植相关死亡率（TRM）的置信区间为18.4±4%。多因素分析显示，移植时高兰斯基评分（>80）与较低的TRM相关（风险比[HR]，0.9；P<0.0002）。复发率（RI）为33.6±6%。多因素分析显示，移植时高兰斯基评分和慢性移植物抗宿主病（cGvHD）与较低的RI相关（HR分别为0.04；P<0.0005和HR，0.23；P<0.03）。无病生存率（DFS）为57.8±5%。多因素分析中，移植时的疾病状态（HR，0.33；P<0.02）、+90天时的类固醇治疗（HR，5.61；P<0.005）和cGvHD（HR，0.23；P<0.005）对DFS有显著影响。cGvHD的置信区间为63.7±7%。患有cGvHD的患者DFS较好（65±5%），因为RI较低（15.7±6%）且TRM相似（27.4±4%）。这些数据表明，尽管cGvHD发病率较高，但儿童异基因外周血干细胞移植后的长期结局是可以接受的。这些患者复发风险较低，DFS较好。
Zotero 插件