Walker Hannah, Haeusler Gabrielle M, Cole Theresa, Neeland Melanie, Hanna Diane, Shanthikumar Shivanthan
Children's Cancer Centre Royal Children's Hospital Parkville VIC Australia.
Department of Paediatrics University of Melbourne Parkville VIC Australia.
Clin Transl Immunology. 2024 Sep 17;13(9):e70002. doi: 10.1002/cti2.70002. eCollection 2024 Sep.
Haematopoietic cell transplant (HCT) is a cellular therapy for a group of high-risk children with cancer, immunodeficiency and metabolic disorders. Whilst curative for a child's underlying condition, HCT has significant risks associated, including lung injury. These complications are associated with increased post HCT mortality and require improved methods of risk stratification, diagnosis and treatment.
Biomarkers measured in bronchoalveolar fluid and peripheral blood have been identified for both acute and chronic lung injury post HCT.This review evaluates the current research available investigating the use of these biomarkers to improve clinical care, with a focus on the paediatric cohort.
Elevated levels of cytokines such as IL-6, IL-8, G-CSF and TNF were identified as potential predictive biomarkers for the development of post HCT lung disease. The pulmonary microbiome was found to have strong potential as a biomarker pre and post HCT for the development of pulmonary complications. General limitations of the studies identified were study design, retrospective or single centre and not exclusively performed in the paediatric population.
To translate biomarker discovery into clinical implementation further research is required, utilising larger cohorts of children in prospective trials to validate these biomarkers and determine how they can be translated into better outcomes for children post HCT.
造血细胞移植（HCT）是一种针对患有癌症、免疫缺陷和代谢紊乱的高危儿童群体的细胞疗法。虽然HCT可治愈儿童的潜在疾病，但它也有显著的相关风险，包括肺损伤。这些并发症与HCT后死亡率增加有关，需要改进风险分层、诊断和治疗方法。
已确定了在支气管肺泡灌洗液和外周血中测量的生物标志物，用于HCT后急性和慢性肺损伤的评估。本综述评估了目前有关使用这些生物标志物改善临床护理的研究，重点关注儿科队列。
白细胞介素-6（IL-6）、白细胞介素-8（IL-8）、粒细胞集落刺激因子（G-CSF）和肿瘤坏死因子（TNF）等细胞因子水平升高被确定为HCT后肺部疾病发生的潜在预测生物标志物。发现肺部微生物群作为HCT前后肺部并发症发生的生物标志物具有很大潜力。所确定研究的一般局限性在于研究设计、回顾性或单中心研究，且并非专门在儿科人群中进行。
为了将生物标志物的发现转化为临床应用，需要进一步开展研究，在前瞻性试验中纳入更多儿童队列，以验证这些生物标志物，并确定如何将它们转化为改善HCT后儿童的治疗效果。
