Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research.
Transplant Outcomes for Children with T Cell Acute Lymphoblastic Leukemia in Second Remission: A Report from the Center for International Blood and Marrow Transplant Research.
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DOI：
10.1016/j.bbmt.2015.08.023
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发表时间：
2015-12
期刊：
影响因子：
--
通讯作者：
Kitko CL
中科院分区：
文献类型：
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作者：
Burke MJ;Verneris MR;Le Rademacher J;He W;Abdel-Azim H;Abraham AA;Auletta JJ;Ayas M;Brown VI;Cairo MS;Chan KW;Diaz Perez MA;Dvorak CC;Egeler RM;Eldjerou L;Frangoul H;Guilcher GMT;Hayashi RJ;Ibrahim A;Kasow KA;Leung WH;Olsson RF;Pulsipher MA;Shah N;Shah NN;Thiel E;Talano JA;Kitko CL
仅用化疗治疗复发性T-ALL的儿童存活率很低，异基因造血细胞移植(HCT)后的结果也没有得到很好的描述。在2000年至2011年间，229名T-ALL儿童在第二次完全缓解(CR2)后接受了清髓调节后的HCT，并被报告给国际血液和骨髓移植研究中心(CIBMTR)。中位年龄10岁(范围2-18岁)。供者来源为脐带血(26%)、相合同胞骨髓(38%)或无关骨髓/外周血(36%)。急性移植物抗宿主病(GVHD)和慢性移植物抗宿主病(GVHD)的发生率分别为35%(95%CI，27~45)和26%(95%CI，20~33)。移植相关的100d死亡率和3年复发率分别为13%(95%CI，9-18)和30%(95%CI，24-37)。3年总生存率和无瘤生存率分别为48%(95%CI，41~55)和46%(95%CI，39~52%)。在多变量分析中，与单纯髓外疾病相比，骨髓复发的患者，无论是否合并髓外复发，与单纯髓外疾病相比，最有可能复发(HR=3.94p=0.005)。总之，CR2中的儿童T-ALL的HCT显示出合理和持久的结果，因此有必要考虑HCT。
Survival for children with relapsed T-ALL is poor when treated with chemotherapy alone and outcomes after allogeneic hematopoietic cell transplantation (HCT) is not well described. Two hundred and twenty-nine children with T-ALL in second complete remission (CR2) received a HCT following myeloablative conditioning between 2000–2011 and were reported to the Center for International Blood and Marrow Transplant Research (CIBMTR). Median age was 10 (range, 2–18) years. Donor source was umbilical cord blood (26%), matched sibling bone marrow (38%) or unrelated bone marrow/peripheral blood (36%). Acute GVHD (grade 2–4) and chronic GVHD occurred in 35% (95% CI, 27–45) and 26% (95% CI, 20–33) of patients. Transplant related mortality at day 100 and 3-year relapse rates were 13% (95% CI, 9–18) and 30% (95% CI, 24–37) respectively. Three year overall survival and disease-free survival were 48% (95% CI, 41–55) and 46% (95% CI, 39–52%) respectively. In multivariate analysis, patients with bone marrow relapse, with or without concurrent extramedullary relapse prior to HCT, were most likely to relapse (HR=3.94, p=0.005) as compared to isolated extramedullary disease. In conclusion, HCT for pediatric T-ALL in CR2 demonstrates reasonable and durable outcomes and consideration for HCT is warranted.