Outcome of Myeloablative Conditioning and Unrelated Donor Hematopoietic Cell Transplantation for Childhood Acute Lymphoblastic Leukemia in Third Remission
Outcome of Myeloablative Conditioning and Unrelated Donor Hematopoietic Cell Transplantation for Childhood Acute Lymphoblastic Leukemia in Third Remission
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DOI：
10.1016/j.bbmt.2011.05.014
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发表时间：
2011-12-01
影响因子：
4.3
通讯作者：
Carpenter, Paul A.
中科院分区：
文献类型：
--
作者：
Nemecek, Eneida R.;Ellis, Kristin;Carpenter, Paul A.
我们对1990年至2005年期间接受非亲缘供者造血细胞移植（HCT）治疗急性淋巴细胞白血病第三次缓解的155例儿童进行了回顾性研究。中位患者年龄为11岁，从诊断到首次复发的中位时间为36个月，从首次复发到第二次复发的中位时间为26个月。干细胞来源是骨髓（n = 115）、外周血（n = 111）和脐带血（n = 29）。所有患者均接受清髓性移植前预处理方案。5年无白血病生存率、复发率和非复发死亡率的估计值分别为30%、25%和45%。在多变量分析中，与复发相关的唯一危险因素是第一次复发和第二次复发之间的间隔。与诊断后36个月发生的第二次复发相比，第一次复发>26个月发生的第二次复发与HCT后复发的风险较低相关，如9%的3年复发率所示（P =.0009）。我们的数据表明，长期的无白血病生存可以实现在儿童急性淋巴细胞白血病的第三次缓解使用无关供体HCT，特别是当第二次复发发生晚。Biol Blood Marrow Transplant 17：1833-1840（2011）（C）2011美国血液和骨髓移植学会
We conducted a retrospective study of 155 children who underwent unrelated donor hematopoietic cell transplantation (HCT) between 1990 and 2005 for acute lymphoblastic leukemia in third remission. The median patient age was 1 I years, the median time from diagnosis to first relapse was 36 months, and the median time from first relapse to second relapse was 26 months. Stem cell sources were bone marrow (n = 115), peripheral blood (n = I I), and cord blood (n = 29). All patients received a myeloablative pre-transplantation conditioning regimen. The 5-year estimates of leukemia-free survival, relapse, and nonrelapse mortality were 30%, 25%, and 45%, respectively. In multivariate analysis, the only risk factor associated with relapse was the interval between the first relapse and the second relapse. Second relapses occurring >26 months from the first relapse were associated with lower risk for post-HCT relapse compared with second relapses occurring at 36 months from diagnosis), as demonstrated by a 3-year relapse rate of 9% (P =.0009). Our data indicate that long-term leukemia-free survival can be achieved in children with acute lymphoblastic leukemia in third remission using unrelated donor HCT, especially when the second relapse occurs late. Biol Blood Marrow Transplant 17: 1833-1840 (2011) (C) 2011 American Society for Blood and Marrow Transplantation