异基因造血干细胞移植治疗儿童急性髓系白血病的临床观察

doi:10.3969/j.issn.1006-7795.2019.02.002

首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (2): 163-168.doi: 10.3969/j.issn.1006-7795.2019.02.002

• 肿瘤的免疫治疗与代谢 • 上一篇下一篇

异基因造血干细胞移植治疗儿童急性髓系白血病的临床观察

贾晨光, 周翾, 王彬, 朱光华, 秦茂权

国家儿童医学中心首都医科大学附属北京儿童医院血液肿瘤中心儿童血液病与肿瘤分子分型北京市重点实验室儿科学国家重点学科儿科重大疾病研究教育部重点实验室, 北京 100045

收稿日期:2019-01-17 出版日期:2019-03-21 发布日期:2019-04-15
通讯作者: 秦茂权 E-mail:qinmq3966@qq.com
基金资助:
国家科技重大专项（2017ZX09304029004），北京市医院管理局临床医学发展专项经费资助（ZY201404），北京市医院管理局登峰计划（DFL20151101）。

Study of allogeneic stem cell transplantation for pediatric acute myeloid leukemia

Jia Chenguang, Zhou Xuan, Wang Bin, Zhu Guanghua, Qin Maoquan

Beijing Key Laboratory of Pediatric Hematology Oncology;National Key Discipline of Pediatrics(Capital Medical University);Key Laboratory of Major Diseases in Children, Ministry of Education;Hematology Oncology Center, Beijing Children's Hospital, Capital Medical University, National Center for Children's Health, Beijing 100045, China

Received:2019-01-17 Online:2019-03-21 Published:2019-04-15
Supported by:
This study was supported by National Science and Technology Key Projects (2017ZX09304029004), Beijing Municipal Administration of Hospitals Clinical Medicine Development of Special Grant (ZY201404), Beijing Municipal Administration of Hospitals Dengfeng Program (DFL20151101).

摘要/Abstract

摘要： 目的总结分析异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗儿童急性髓系白血病（acute myeloid leukemia，AML）的临床疗效，发现可能影响预后的相关因素。方法收集2006年1月至2016年1月首都医科大学附属北京儿童医院血液肿瘤中心确诊为AML并进行allo-HSCT治疗的病例，采用Kaplan-Meier生存曲线评估患者的总生存率（overall survival，OS），采用Log-rank检验进行不同组别比较。多因素分析采用Cox回归法分析影响预后的相关因素。结果共收集46例病例，中位随访时间27个月。存活31例，15例死亡，8例复发。5年OS为（61.1±8.7）%，中位生存时间为77.3个月，5年累积复发率为（16.0±6.0）%。Log-rank检验结果显示前期后期不同移植方案、移植前缓解状态、缓解次数、不同供者来源、是否合并移植物抗宿主病在对OS影响上差异无统计学意义（P>0.05）。多因素分析显示，合并髓系肉瘤和复发是影响患者预后的危险因素（P<0.05）。结论异基因造血干细胞移植是治疗AML尤其是难治/复发AML的有效治疗手段，随着移植方案的改良及支持治疗的发展，生存率逐年提高。合并髓系肉瘤及复发是影响AML移植治疗预后的重要不良因素。

关键词: 造血干细胞移植, 急性髓系白血病, 儿童

Abstract: Objective To analysis the effectiveness of allogeneic hematopoietic stem cell transplantation (allo-HSCT) for treatment of children with acute myeloid leukemia (AML), and to identify the possible prognostic factors for treatment. Methods We retrospectively reviewed outcomes of children with AML who underwent allo-HSCT at Hematology Oncology Center of Beijing Children's Hospital, Capital Medical University between January of 2006 and January of 2016. The overall survival (OS) were estimated by Kaplan-Meier method, Log-rank test was used to compare the different groups and prognostic factors were evaluated by Cox regression. Results A total of 46 patients were involved, with 31 patients survived, and 15 patients died, 8 patients relapsed, with an average follow-up time of 27 months. 5 years OS was (61.1±8.7)%, median survival time was 77.3 months, and 5 years cumulative relapse rate was(16.0±6.0)%. The results of Log-rank test indicated no significant difference (P>0.05) with different protocol, remission state, remission times, graft versus-host disease (GVHD) and donors. The Cox regression suggested myeloid sarcoma and the relapse are the prognostic factors (P<0.05). Conclusion Allogeneic hematopoietic stem cell transplantation is an effective treatment for AML, especially, refractory/relapsed AML. With the modified conditioning regimen and supportive treatment, the survival rate is increasing year by year. Myeloid sarcoma and relapse are important adverse prognostic factors of HSCT treatment for AML.

Key words: stem cell transplantation, acute myeloid leukemia, pediatric

中图分类号:

R733

贾晨光, 周翾, 王彬, 朱光华, 秦茂权. 异基因造血干细胞移植治疗儿童急性髓系白血病的临床观察[J]. 首都医科大学学报, 2019, 40(2): 163-168.

Jia Chenguang, Zhou Xuan, Wang Bin, Zhu Guanghua, Qin Maoquan. Study of allogeneic stem cell transplantation for pediatric acute myeloid leukemia[J]. Journal of Capital Medical University, 2019, 40(2): 163-168.

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异基因造血干细胞移植治疗儿童急性髓系白血病的临床观察

Study of allogeneic stem cell transplantation for pediatric acute myeloid leukemia

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