自身造血干细胞移植治疗儿童晚期神经母细胞瘤临床报道

Clinical report on the treatment of children with advanced neuroblastoma with autologous haematopoietic stem cell transplantation

目的 神经母细胞瘤是儿童常见的恶性肿瘤 ,即使通过化疗、放疗及手术等综合治疗 ,晚期患儿仍生存率极低。为提高治愈率 ,本中心对 1 1例晚期患儿进行了自身造血干细胞移植术。方法 本组平均年龄 3 8岁 ( 2～ 6岁 ) ,平均体重 1 5 3kg( 1 1 6kg～ 2 0kg)。 2例为原发于胸腔的Ⅲ期患者 ,9例均为原发于腹腔伴有广泛骨髓转移的IV期患儿。虽然大剂量化疗及积极的手术治疗 ,4例患儿移植时原发肿瘤仍未完全清除 ,属带瘤移植。因对其中 2例未缓解患儿进行了两次移植 ,1 1例患儿共进行了 1 3例次移植。 3例次直接采集骨髓 ,另 1 0例次采用外周血造干细胞进行移植。为减少移植后复发 ,4例患儿采集物经CliniMACS进行了CD+3 4细胞分选的净化处理。所有患儿均采用VP1 6 +卡铂 +马法兰的预处理方案。结果 采集骨髓及外周血得到的单个核细胞分别为 ( 5 7± 0 9)× 1 0 8/kg和 ( 5 7± 1 0 )× 1 0 8/kg ,两者之间无显著性差异 (P >0 0 5) ,所有患儿移植后都获造血重建 ,中性粒细胞恢复至 0 5× 1 0 9/L的平均时间为 1 0 5± 5 7天 ,非输血依赖的血小板大于 2 0× 1 0 9/L的时间为 1 6 8±9 4天 ,血小板大于 50× 1 0 9/L的时间为 33 1± 2 0 1天 ,移植过程中平均输注红细胞2 2± 2 0单位 ( 0～ 8单位 )?

Objective Neuroblastoma(NB) is a common solid tu mor in children. Even with active chemotherapy, operation and irradiation, the s urvival rate is still very low in advanced patients. To improve the treatment re sults, autolougous haematopoietic stem cell transplantations have been performed in 11 patients with advanced NB in our hospital. Methods The average age was 3.8 years old(2～6 years old) and the average weight was 15.3 kg(11.6～20 kg) in this group. All 9 Patients were in stage IV with the primar y mass in abdomen and extensive bone marrow involvement but 2 patients in stage Ⅲ with the primary mass in thorax. Although high dose chemotherapy and active o peration was given, 4 cases still have not got complete remission at the time of transplant. As 2 cases received 2 times trasnplant, totally 13 transplants were performed in these 11 children. 3 were collected stem cell from the anterior cr ista of iliac in both sides while another 10 were received the stem cell from th e peripheral mononuclear cell harvested with CS-3000 cell separator after G-CSF mobilization. To reduce the risk of post transplant relapse, 4 cases were purged with CliniMACS based on the CD_ 34 positive selection. All the patients con ditioned with Etopside plus Carboplatin plus Melphalan. Results The number of mononuclear cell collected from bone marrow or peripheral bloo d was equal to 57±0.9×108 /kg and 5.7±1.0×108 /kg respectively( P>0.05). All of them achieved the haematopoietic reconstitution after transpl antation. The mean time for the neutrophile count recovering to 0.5×109/L wa s 10.5±5.7 days and the platelet recovering over 2.0×109/L. The mean tran sfusion independent day was 16.8±9.4 days with average 2 units of packed red blood cells and 4 units of platelet products transfused in the course of transpl antation. The mean fellow up time was 26.7 months. 4/11 children died of relaps e 5 months to 27 months after transplantation. Other 7 children are still in sur vival. None of our children died of complication associated with transplantation . Conclusion Autologous stem cell transplantation is a safe a nd effective measure in the treatment of children with advanced neuroblastoma an d worth of further recommendation. <