Division of Haematology/Oncology, Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Toronto, Canada.
Leuk Lymphoma. 2013 Jan;54(1):105-9. doi: 10.3109/10428194.2012.704998. Epub 2012 Sep 5.
Studies have shown second allogeneic hematopoietic stem cell transplant (HSCT) to have a potential role in treating relapse after HSCT. We sought to evaluate the outcome of second allogeneic HSCT for children with relapsed leukemia with focus on factors that potentially improve outcome. Thirty-eight children were identified. The median time between transplants was 18.6 months (range 6.7-50.1 months). With median follow-up of 44 months the 2-year overall survival (OS) was 59.1 ± 8.2%. The leukemia-free survival was 51.8 ± 8.2% and the non-relapse mortality 30.8 ± 7.9%. Eleven patients (30%) died of non-relapse mortality at a median of 37 days (range 16-260 days) from second HSCT. Twenty-one patients developed acute graft-versus-host disease (aGVHD) after second HSCT. Patients who developed aGVHD had lower risk for mortality compared to patients who did not have aGVHD, with a hazard ratio (HR) of 0.27 (95% confidence interval [CI] 0.095-0.788, p-value 0.0163). Similarly, patients who developed aGVHD following second HSCT had lower risk for relapse (HR = 0.21, 95% CI 0.051-0.857, p-value 0.0297). Patients who developed aGVHD after first HSCT were less likely to benefit from second HSCT compared to patients without aGVHD after first HSCT. Our experience suggests that second HSCT for pediatric relapsed leukemia can result in acceptable survival and aGVHD is associated with improved outcome.
研究表明，第二次异基因造血干细胞移植（HSCT）在治疗 HSCT 后复发方面具有潜在作用。我们旨在评估第二次异基因 HSCT 治疗儿童复发白血病的结果，重点关注可能改善结果的因素。确定了 38 名儿童。两次移植之间的中位时间为 18.6 个月（范围 6.7-50.1 个月）。中位随访 44 个月后，2 年总生存率（OS）为 59.1±8.2%。无白血病生存率为 51.8±8.2%，非复发死亡率为 30.8±7.9%。11 名患者（30%）在第二次 HSCT 后 37 天（范围 16-260 天）中位数死于非复发死亡。21 名患者在第二次 HSCT 后发生急性移植物抗宿主病（aGVHD）。与未发生 aGVHD 的患者相比，发生 aGVHD 的患者死亡率较低，风险比（HR）为 0.27（95%置信区间 [CI] 0.095-0.788，p 值 0.0163）。同样，第二次 HSCT 后发生 aGVHD 的患者复发风险较低（HR=0.21，95%CI 0.051-0.857，p 值 0.0297）。与第一次 HSCT 后未发生 aGVHD 的患者相比，第一次 HSCT 后发生 aGVHD 的患者从第二次 HSCT 中获益的可能性较小。我们的经验表明，第二次异基因 HSCT 治疗儿童复发白血病可获得可接受的生存率，aGVHD 与改善结果相关。
