Baldo Francesco, Simeone Roberto, Marcuzzi Annalisa, Grasso Antonio Giacomo, Vidimari Rossella, Ciriello Francesca, Zanon Davide, Maestro Alessandra, Barbi Egidio, Maximova Natalia
Department of Medicine, Surgery and Health Sciences, University of Trieste, Piazzale Europa 1, 34127 Trieste, Italy.
Department of Transfusion Medicine, ASUGI, Piazza dell'Ospitale 1, 34125 Trieste, Italy.
J Clin Med. 2021 Aug 26;10(17):3834. doi: 10.3390/jcm10173834.
Total body irradiation (TBI) is a mandatory step for patients with acute lymphoblastic leukemia (ALL), undergoing allogeneic hematopoietic stem cell transplantation (HSCT). In the past, amylases have been reported to be a possible sign of TBI toxicity. We investigated the relationship between total amylases (TA) and transplant-related outcomes in pediatric recipients.
We retrospectively analyzed the medical records of all the patients who underwent allogeneic HSCT between January 2000 and November 2019. The inclusion criteria were the following: recipient's age between 2 and 18, diagnosis of ALL, no previous transplantation, and use of TBI-based conditioning. The serum total amylase and pancreatic amylase were evaluated before, during, and after transplantation. Cytokines and chemokines assays were retrospectively performed.
78 patients fulfilled the inclusion criteria. Fifty-seven patients were treated with fractionated TBI, and 21 with a single-dose regimen. The overall survival (OS) was 62.8%. Elevated values of TA were detected in 71 patients (91%). The TA were excellent in predicting the OS (AUC = 0.773; 95% CI = 0.66-0.86; < 0.001). TA values below 374 U/L were correlated with a higher OS. The highest mean TA values (673 U/L) were associated with a high disease-progression mortality rate. The TA showed a high predictive performance for disease progression-related death (AUC = 0.865; 95% CI = 0.77-0.93; < 0.0001). Elevated TA values were also connected with significantly higher levels of proinflammatory cytokines, such as TNF-α, IL-6, and RANTES ( < 0.001).
this study shows that TA is a valuable predictor of post-transplant OS and increased risk of leukemia relapse.
全身照射（TBI）是急性淋巴细胞白血病（ALL）患者接受异基因造血干细胞移植（HSCT）的必要步骤。过去，淀粉酶曾被报道可能是TBI毒性的一个迹象。我们研究了小儿受者血清总淀粉酶（TA）与移植相关结局之间的关系。
我们回顾性分析了2000年1月至2019年11月期间所有接受异基因HSCT患者的病历。纳入标准如下：受者年龄在2至18岁之间，诊断为ALL，既往未接受过移植，且采用基于TBI的预处理方案。在移植前、移植期间和移植后评估血清总淀粉酶和胰腺淀粉酶。回顾性进行细胞因子和趋化因子检测。
78例患者符合纳入标准。57例患者接受分次TBI治疗，21例接受单剂量方案治疗。总生存率（OS）为62.8%。71例患者（91%）检测到TA值升高。TA在预测OS方面表现出色（AUC = 0.773；95% CI = 0.66 - 0.86；P < 0.001）。TA值低于374 U/L与较高的OS相关。最高平均TA值（673 U/L）与高疾病进展死亡率相关。TA对疾病进展相关死亡具有较高的预测性能（AUC = 0.865；95% CI = 0.77 - 0.93；P < 0.0001）。TA值升高还与促炎细胞因子如TNF-α、IL-6和RANTES的水平显著升高相关（P < 0.001）。
本研究表明，TA是移植后OS和白血病复发风险增加的有价值预测指标。
