Truong T H, Moorjani R, Dewey D, Guilcher G M T, Prokopishyn N L, Lewis V A
Section of Pediatric Oncology, Blood and Marrow Transplant, Department of Oncology and Pediatrics, Alberta Children's Hospital, University of Calgary, Calgary, Canada.
Department of Pediatrics and Community Health Sciences, University of Calgary, Alberta Children's Hospital Research Institute for Child and Maternal Health, Calgary, Canada.
Bone Marrow Transplant. 2016 May;51(5):680-6. doi: 10.1038/bmt.2015.331. Epub 2016 Jan 11.
Adverse reactions (ARs) during the infusion of cellular therapy products (CTPs) are common in patients undergoing hematopoietic stem cell transplantation (HSCT). We retrospectively studied pediatric patients undergoing autologous and allogeneic HSCT to determine the incidence and grade of ARs during stem cell infusion and their predictors. We analyzed data from 213 patients (120 allogeneic and 93 autologous) who received at least 1 CTP, totaling 361 infusion episodes. Serious ARs, defined as grade 2 and 3, occurred in 25 and 11% of infusions, respectively. No grade 4 or 5 ARs were noted. Independent risk factors for developing a serious AR included stem cell source (PBSC vs marrow (odds ratio (OR) 1.8, 95% confidence interval (CI): 0.4-9); cord vs marrow (OR 7.3, 95% CI: 1.3-40), overall P=0.0001) but manipulated CTPs were protective (OR 0.4, 95% CI: 0.2-0.7, P=0.004). Unlike previous adult studies, WBC and granulocyte content were not found to be risk factors in this pediatric population. These data suggest that children tolerate higher WBC content during infusion of CTPs and support the use of manipulated CTP, as indicated, to reduce the risk of adverse infusion reactions.
在接受造血干细胞移植（HSCT）的患者中，细胞治疗产品（CTP）输注期间的不良反应（AR）很常见。我们对接受自体和异基因HSCT的儿科患者进行了回顾性研究，以确定干细胞输注期间AR的发生率和分级及其预测因素。我们分析了213例接受至少1次CTP的患者（120例异基因和93例自体）的数据，总共361次输注事件。定义为2级和3级的严重AR分别发生在25%和11%的输注中。未观察到4级或5级AR。发生严重AR的独立危险因素包括干细胞来源（外周血干细胞与骨髓相比（优势比（OR）1.8，95%置信区间（CI）：0.4 - 9）；脐带血与骨髓相比（OR 7.3，95%CI：1.3 - 40），总体P = 0.0001），但经过处理的CTP具有保护作用（OR 0.4，95%CI：0.2 - 0.7，P = 0.004）。与先前的成人研究不同，在这个儿科人群中，白细胞和粒细胞含量未被发现是危险因素。这些数据表明，儿童在CTP输注期间能够耐受更高的白细胞含量，并支持使用经过处理的CTP，以降低输注不良反应的风险。
