Liu Chang, Liu Minyuan, Liu Xin, Li Bohan, Gao Li, Wu Shuiyan, Ji Qi, Zhang Zhiqi, Zhang Senlin, Xiao Peifang, Lu Jun, Li Jie, Hu Shaoyan
Department of Hematology, Children's Hospital of Soochow University, Suzhou, China.
Department of Hematological Intensive Care Unit, Children's Hospital of Soochow University, Suzhou, China.
Ther Adv Hematol. 2024 Sep 26;15:20406207241277549. doi: 10.1177/20406207241277549. eCollection 2024.
There is limited data on third-party umbilical cord blood (UCB) or mesenchymal stem cell (MSC) transplantation-assisted haploidentical hematopoietic stem cell transplantation (haplo-HSCT) in pediatric patients.
To evaluate the efficacy and safety of UCB and MSC transplantation-assisted haplo-HSCT in pediatric patients with acute leukemia (AL).
Observational study.
Clinical data of 152 children with AL undergoing haplo-HSCT at the Children's Hospital of Soochow University between January 2020 and June 2022 were collected. The patients were divided into the haplo-HSCT + UCB group ( = 76), haplo-HSCT + MSC group ( = 31), and haplo-HSCT group ( = 45). Hematopoietic reconstruction time, complications within 30 days after transplantation, and survival and recurrence at 3 years after transplantation were compared among the groups.
Multivariate analysis revealed that haplo-HSCT with MSC and human leukocyte antigen (HLA) matching ⩾6/10 were independent factors reducing engraftment syndrome (ES) incidence. There were no significant differences among the groups in the hematopoietic reconstruction time or incidence of complications within 30 days after transplantation ( > 0.05). Overall survival, relapse-free survival, cumulative incidence of relapse, cumulative incidence of hematological relapse, and 3-year transplant-related mortality were not significantly different ( > 0.05). The incidence of adverse reactions in the haplo-HSCT + UCB group was 97.3% within 4 h after UCB infusion, with a particularly high occurrence rate of 94.7% for hypertension. No transfusion-related adverse reactions occurred after the transfusion of umbilical cord MSC in the haplo-HSCT + MSC group.
MSC-assisted haplo-HSCT can reduce ES incidence after transplantation in pediatric patients with AL. UCB infusion is associated with a high incidence of reversible hypertension. However, no adverse reactions were observed in umbilical cord MSC transfusion.
关于第三方脐带血（UCB）或间充质干细胞（MSC）移植辅助单倍体造血干细胞移植（haplo-HSCT）在儿科患者中的数据有限。
评估UCB和MSC移植辅助haplo-HSCT在小儿急性白血病（AL）患者中的疗效和安全性。
观察性研究。
收集2020年1月至2022年6月在苏州大学附属儿童医院接受haplo-HSCT的152例AL患儿的临床资料。将患者分为haplo-HSCT+UCB组（n=76）、haplo-HSCT+MSC组（n=31）和haplo-HSCT组（n=45）。比较各组造血重建时间、移植后30天内的并发症以及移植后3年的生存和复发情况。
多因素分析显示，采用MSC且人类白细胞抗原（HLA）匹配≥6/10的haplo-HSCT是降低植入综合征（ES）发生率的独立因素。各组间造血重建时间或移植后30天内并发症发生率无显著差异（P>0.05）。总生存、无复发生存、复发累积发生率、血液学复发累积发生率和3年移植相关死亡率无显著差异（P>0.05）。haplo-HSCT+UCB组在UCB输注后4小时内不良反应发生率为97.3%，其中高血压发生率特别高，为94.7%。haplo-HSCT+MSC组输注脐带MSC后未发生输血相关不良反应。
MSC辅助的haplo-HSCT可降低小儿AL患者移植后ES发生率。UCB输注与可逆性高血压高发生率相关。然而，脐带MSC输血未观察到不良反应。
