Effect of reduced-intensity conditioning and the risk of late-onset non-infectious pulmonary complications in pediatric patients.
Effect of reduced-intensity conditioning and the risk of late-onset non-infectious pulmonary complications in pediatric patients.
复制标题
降低强度调理的效果和儿科患者迟发性非感染性肺部并发症的风险。
DOI：
10.1111/ejh.12967
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发表时间：
2017
期刊：
影响因子：
3.1
通讯作者：
Morio T.
中科院分区：
文献类型：
--
作者：
Nagasawa M;Mitsuiki N;Aoki Y;Ono T;Isoda T;Imai K;Takagi M;Kajiwara M;Kanegane H;Morio T.
目的：异基因造血干细胞移植（allo - HSCT）后，延迟发生的非感染性肺部并发症（LONIPCs）导致更高的发病率和死亡率。因此，我们调查了儿科患者LONIPCs的危险因素。方法2001年至2011年间，74例儿童患者（年龄范围7个月至22.7岁，中位年龄6.5岁），包括29例原发性免疫缺陷患者，在我院接受了80例同种异体造血干细胞移植。回顾性分析了67例在同种异体造血干细胞移植后存活超过3个月的患者。中位随访期为1973天（126 - 5 - 145天）。结果9例（13.4%）患者在移植后90 ~ 3578天发生LONIPCs。骨髓清除调节（MAC）方案和慢性GVHD被确定为LONIPCs的重要危险因素。接受降低强度调节（RIC）方案的18例患者中没有发生LONIPCs，尽管MAC方案和RIC方案的总生存期没有差异。值得注意的是，两名免疫缺陷患者在2岁以下接受了以布苏凡为基础的MAC方案，分别在SCT后5年和10年发生了LONIPC，没有慢性GVHD病史，这表明布苏凡具有直接毒性。结论：我们的研究结果表明RIC方案降低了儿科患者LONIPCs的风险。
ObjectiveLate‐onset non‐infectious pulmonary complications (LONIPCs) contribute to higher morbidity and mortality after allogeneic hematopoietic stem cell transplantation (allo‐HSCT). Therefore, we investigated the risk factors of LONIPCs in pediatric patients.MethodBetween 2001 and 2011, 74 pediatric patients (range, 7 months to 22.7 years old; median 6.5 years old), including 29 with a primary immunodeficiency, underwent 80 allo‐HSCTs at our institution. Sixty‐seven patients who survived more than 3 months after allo‐HSCT were analyzed retrospectively. The median follow‐up period was 1 973 days (range, 126‐5 145 days).ResultsNine patients (13.4%) developed LONIPCs between 90 and 3 578 days after allo‐HSCT. A myeloablative conditioning (MAC) regimen and chronic GVHD were determined as significant risk factors of LONIPCs. None of 18 patients who received the reduced‐intensity conditioning (RIC) regimen developed LONIPCs, although there was no difference in overall survival between the MAC and RIC regimen. Notably, two immunodeficient patients who received busulfan‐based MAC regimen under 2 years old developed LONIPC with no history of chronic GVHD after 5 years and 10 years from SCT, respectively, suggesting the direct toxicity of busulfan.ConclusionOur study's findings indicate that the RIC regimen reduces the risk of LONIPCs in pediatric patients.