Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Department of Pediatrics, The University of Tokyo, Tokyo, Japan.
Department of Social Medicine, National Center for Child Health and Development, Tokyo, Japan; Graduate School of Public Health, St Luke's International University, Tokyo, Japan.
Biol Blood Marrow Transplant. 2019 Aug;25(8):1597-1602. doi: 10.1016/j.bbmt.2019.04.014. Epub 2019 Apr 17.
Hematologic stem cell transplantation (HSCT) is the most potent consolidation therapy for high-risk acute lymphoblastic leukemia (ALL), but their outcomes and complications in adolescent and young adult (AYA) patients remain unclear. We compared outcomes after HSCT for ALL among children (age 1 to 9 years; n = 607), adolescents (age 10 to 19 years; n = 783), and young adults (age 20 to 29 years old, n = 603), based on Japanese nationwide registry data. The 5-year overall survival (OS) rate among AYA patients was worse than that of children, at 64% (95% confidence interval [CI], 60% to 68%). In the AYA, the 5-year treatment-related mortality (TRM) after HSCT was 19% (95% CI, 16% to 22%), significantly higher than that in younger patients. The most common cause of TRM in the AYA was infection. The relapse rate was not different across the 3 age groups. When focusing on older adolescents (age 15 to 19 years), there was no difference in outcomes between those treated in pediatric centers and those treated in adult centers. In conclusion, the AYA had a greater risk of nonrelapse death than younger patients, and infection was the most common cause. Further optimization is required for HSCT in AYAs with ALL.
造血干细胞移植（HSCT）是高危急性淋巴细胞白血病（ALL）最有效的巩固治疗方法，但青少年和年轻成人（AYA）患者的结果和并发症仍不清楚。我们根据日本全国登记数据比较了儿童（1 至 9 岁；n=607）、青少年（10 至 19 岁；n=783）和年轻成人（20 至 29 岁；n=603）接受 ALL 造血干细胞移植后的结果。AYA 患者的 5 年总生存率（OS）比儿童差，为 64%（95%置信区间 [CI]，60%至 68%）。在 AYA 中，HSCT 后 5 年治疗相关死亡率（TRM）为 19%（95%CI，16%至 22%），显著高于年轻患者。TRM 的最常见原因是感染。3 个年龄组的复发率没有差异。当关注年龄较大的青少年（15 至 19 岁）时，在儿科中心和成人中心接受治疗的患者之间的结果没有差异。总之，AYA 患者非复发死亡的风险高于年轻患者，感染是最常见的原因。需要进一步优化 ALL 中 AYA 的 HSCT。
