Vowels M, Chan L L, Giri N, Russell S, Lam-Po-Tang R
Department of Haematology/Oncology, Prince of Wales Children's Hospital, Randwick, Australia.
Bone Marrow Transplant. 1993 Oct;12(4):347-50.
Permanent alopecia after BMT has been reported as a side-effect associated with GVHD or after busulphan conditioning therapy, primarily in adults. We have reviewed children undergoing BMT to document the frequency of incomplete hair regrowth and to evaluate factors associated with this problem. Hair regrowth was studied in 74 children who survived > 6 months following BMT undertaken for malignant and non-malignant diseases. Alopecia was categorised as severe (< 50% of pre-transplant status), moderate (50-75%) or mild (> 75% but less than normal). Overall, 18 (24.3%) of 74 patients had mild (n = 5), moderate (n = 4) or severe (n = 9) alopecia. Risk factors for alopecia were presence of chronic GVHD (67%; p < 0.001), older age (p < 0.001) and prior cranial irradiation (42%; p = 0.03). Alopecia occurred in children receiving either busulphan (31%) or total body irradiation (16%; p = 0.15) as conditioning therapy. The highest frequency was seen in patients conditioned with busulphan with or without melphalan and who received prior cranial irradiation and/or developed chronic GVHD (75%). These data indicate that alopecia after BMT in children is a significant problem and confirm, in children, the previously noted association between alopecia and chronic GVHD and busulphan. Further risk factors of older age and prior cranial irradiation are identified. Consideration needs to be given to the use of an alternative to busulphan in children who are of older age, have received prior cranial irradiation and/or are at increased risk of GVHD.
据报道，骨髓移植（BMT）后永久性脱发是一种与移植物抗宿主病（GVHD）或白消安预处理疗法相关的副作用，主要发生在成人中。我们回顾了接受BMT的儿童，以记录头发再生不完全的频率，并评估与此问题相关的因素。对74名因恶性和非恶性疾病接受BMT后存活超过6个月的儿童进行了头发再生研究。脱发被分为严重（<移植前状态的50%）、中度（50 - 75%）或轻度（> 75%但低于正常）。总体而言，74例患者中有18例（24.3%）出现轻度（n = 5）、中度（n = 4）或重度（n = 9）脱发。脱发的危险因素包括慢性GVHD的存在（67%；p < 0.001）、年龄较大（p < 0.001）和既往颅脑照射（42%；p = 0.03）。接受白消安（31%）或全身照射（16%；p = 0.15）作为预处理疗法的儿童出现了脱发。在接受白消安联合或不联合美法仑预处理且接受过既往颅脑照射和/或发生慢性GVHD的患者中，脱发频率最高（75%）。这些数据表明，儿童BMT后的脱发是一个重要问题，并在儿童中证实了先前指出的脱发与慢性GVHD和白消安之间的关联。还确定了年龄较大和既往颅脑照射等进一步的危险因素。对于年龄较大、接受过既往颅脑照射和/或GVHD风险增加的儿童，需要考虑使用白消安的替代方案。
