Zhang Ya-Ting, Huang Ke, Xu Lv-Hong, Han Xia-Wei, Li Xin-Yu, Fang Jian-Pei
Department of Pediatrics, SUN Yat-Sen Memorial Hospital, SUN Yat-Sen University, Guangzhou 510120, Guangdong Province, China.
Department of Pediatrics, SUN Yat-Sen Memorial Hospital, SUN Yat-Sen University, Guangzhou 510120, Guangdong Province, China,E-mail:
Zhongguo Shi Yan Xue Ye Xue Za Zhi. 2020 Jun;28(3):737-741. doi: 10.19746/j.cnki.issn.1009-2137.2020.03.004.
To investigate the efficacy and safety of combination chidamide and hematopoietic stem cell transplantation (HSCT) in the treatment of childhood acute T lymphoblastic leukemia (T-ALL).
Seven children with acute T lymphoblastic leukemia received hematopoietic stem cell transplantation in SUN Yat-Sen Memorial Hospital of SUN Yat-Sen University were selected. 7 cases of T-ALL were divided into 2 groups: HSCT plus chidamide-treated group (4 cases) and traditional HSCT-treated group (3 cases) as control. The incidence of GVHD and other related complications, as well as implantation, recurrence and survival were compared between the two groups, and the side effects of chidamide were observed. All the patients were follow-up until January 2019.
All the 7 patients were alive and, there was no difference in the incidence of acute GVHD between the HSCT plus chidamides treated group and the traditional HSCT-treated group. The implantation rate of HSCT was 100%, and there were no recurrence occurred. During the application of chidamide, 3 cases showed adverse reactions, of which 2 cases had adverse reactions of grade 3 or higher, and 2 cases were hematological adverse reactions (neutropenia, thrombocytopenia), other adverse reactions were non-hematologic adverse reactions (transaminase elevation, fatigue, nausea, vomiting), there were no serious adverse reactions occurred. In the HSCT plus chidamide-treated group, 2 cases were found that mature lymphocytes were not expressed by tumors, during examing for minimal redidaul disease (MRD). Compared with the immunophenotype and TCR rearrangement at first diagnosis, the results did not support the source of residual T-ALL tumor cells. During the review of MRD, it was found that the abnormal T cells showed an increasing trend, indicating that chidamide might induce leukemia cell differentiation through some pathways.
Hematopoietic stem cell transplantation is still an effective method to cure children's T-ALL. In some cases, abnormal T-cell nonclonal amplification occurs during the application of chidamide, and the children with T-ALL can tolerable adverse reactions of chidamide.
探讨西达本胺联合造血干细胞移植（HSCT）治疗儿童急性T淋巴细胞白血病（T-ALL）的疗效及安全性。
选取中山大学孙逸仙纪念医院接受造血干细胞移植的7例急性T淋巴细胞白血病患儿。7例T-ALL患儿分为2组：HSCT联合西达本胺治疗组（4例）和传统HSCT治疗组（3例）作为对照。比较两组间移植物抗宿主病（GVHD）及其他相关并发症的发生率，以及植入、复发和生存情况，并观察西达本胺的副作用。所有患者随访至2019年1月。
7例患者均存活，HSCT联合西达本胺治疗组与传统HSCT治疗组急性GVHD发生率无差异。HSCT植入率为100%，无复发发生。应用西达本胺期间，3例出现不良反应，其中2例为3级及以上不良反应，2例为血液学不良反应（中性粒细胞减少、血小板减少），其他不良反应为非血液学不良反应（转氨酶升高、乏力、恶心、呕吐），未发生严重不良反应。在HSCT联合西达本胺治疗组中，2例在检测微小残留病（MRD）时发现肿瘤未表达成熟淋巴细胞。与初诊时的免疫表型和TCR重排相比，结果不支持残留T-ALL肿瘤细胞的来源。在MRD复查时发现异常T细胞呈上升趋势，提示西达本胺可能通过某些途径诱导白血病细胞分化。
造血干细胞移植仍是治愈儿童T-ALL的有效方法。在某些情况下，应用西达本胺期间会出现异常T细胞非克隆性扩增，T-ALL患儿对西达本胺的不良反应可耐受。
