Kato Koji, Sakaguchi Hirotoshi, Muramatsu Hideki, Sekiya Yuko, Kawashima Nozomu, Narita Atsushi, Doisaki Sayoko, Watanabe Nobuhiro, Yoshida Nao, Matsumoto Kimikazu
Department of Hematology and Oncology, Children's Medical Center, Japanese Red Cross Nagoya First Hospital, Nagoya, Japan.
Department of Pediatrics, Nagoya University Graduate School of Medicine, Nagoya, Japan.
Pediatr Transplant. 2018 Mar;22(2). doi: 10.1111/petr.13099. Epub 2017 Dec 13.
In SCT, death from transplant-related complications is the major obstacle hindering improvement of transplant outcomes, and proper supportive care is essential to reduce TRM. The transplant outcomes of 210 pediatric patients with malignant and non-malignant disorders who consecutively underwent SCT in our institution from 2000 to 2013 were analyzed. The transplant years were divided into three periods: A (2000-2004), B (2005-2008), and C (2009-2013), and an improvement in 5-year OS and a decrease in 5-year TRM were observed over these time periods; that is, OS was 61.5%, 60.3%, and 79.5% (P = .062), and TRM was 19.9%, 7.9%, and 0.0% (P < .001) in periods A, B, and C, respectively. On multivariate analysis, the prognostic factor for TRM for all patients was administration of danaparoid (HR = 0.109, 95% CI = 0.033-0.363, P < .001), and for patients with hematological malignancies in allogeneic SCT, the prognostic factors were danaparoid (HR = 0.046, 95% CI = 0.006-0.326, P = .002) and advanced disease at SCT (HR = 4.802, 95% CI = 1.734-13.30, P = .003). A reduction in TRM after SCT was observed over the time periods, and supportive care with danaparoid was found to be significantly effective in reducing TRM in SCT for children.
在造血干细胞移植（SCT）中，移植相关并发症导致的死亡是阻碍移植结局改善的主要障碍，适当的支持治疗对于降低移植相关死亡率（TRM）至关重要。分析了2000年至2013年在我院连续接受SCT的210例患有恶性和非恶性疾病的儿科患者的移植结局。移植年份分为三个时期：A（2000 - 2004年）、B（2005 - 2008年）和C（2009 - 2013年），在这些时间段内观察到5年总生存率（OS）有所提高，5年TRM有所下降；也就是说，A、B和C期的OS分别为61.5%、60.3%和79.5%（P = 0.062），TRM分别为19.9%、7.9%和0.0%（P < 0.001）。多因素分析显示，所有患者TRM的预后因素是使用达那肝素（HR = 0.109，95%可信区间[CI] = 0.033 - 0.363，P < 0.001），对于接受异基因SCT的血液系统恶性肿瘤患者，预后因素是达那肝素（HR = 0.046，95% CI = 0.006 - 0.326，P = 0.002）和SCT时疾病晚期（HR = 4.802，95% CI = 1.734 - 13.30，P = 0.003）。在各个时间段内均观察到SCT后TRM有所降低，并且发现使用达那肝素的支持治疗在降低儿童SCT中的TRM方面显著有效。
