造血干细胞移植在儿童急性白血病中的应用进展

Study Progress of Hematopioetic Stem Cell Transplantation Therapy on Acute Leukemia in Children

造血干细胞移植是治疗急性白血病(AL)的手段之一。对于高危ALL,如Ph+和T细胞型,第1次完全缓解(CR1)后行异基因造血干细胞移植(allo-HSCT)的整体生存率(OS)和无瘤生存率(DFS)优于化疗,对于CR2首选allo-HSCT,尤其对于早期复发者;对于CR3后采用allo-HSCT,通过诱导移植物抗白血病降低复发率。移植ALL采用含全身照射方案有优势。对于AMLCR1后allo-HSCT在OS和DFS优于化疗,AML第2次复发时,如获得供者,allo-HSCT治疗为首选,AML行移植后复发者,可行二次移植。移植AML采用含TBI方案无优势,采用G-CSF与大剂量阿糖胞苷方案,可提高DFS。非血缘脐血具有许多优点,在DFS和复发率与无关骨髓移植相当,是造血干细胞的一种来源。

Hematopoietic stem cell transplantation （HSCT） is one of the measures therapy on acute leukemia in children. Very - high - risk children with acute lymphocytic leukemia （ALL）, such as Philadelphia chromosome -positive（ Ph ^＋ ） ,T cell immunophenotype ,achieved the first complete remission （ CR1 ）, and then receive allogeneic HSCT （ allo - HSCT）. The transplantation group had significantly improved disease- free survival（DFS） and overall survival（OS） compared with chemotherapy group. ALL children in the second complete remission （CR2） were recommended to receive allo -HSCT, especially early -relapse group. All children in the third complete remission （CR3） were recommended to receive an allo - HSCT, and reduce replapse rate through inducing graft versus leukemia. Total body irradiation - based conditioning regimens in children with ALL has advantage over chemotherapy conditioning regimens. Children with acute myeloblastic leukemia （AML） achieved CR1 and then undergo all - HSCT. This group had significantly improved DFS and OS compared with chemotherapy group. The children with relapsed AML,if having suitable donor, were recommended to receive allo - HSCT. The children with AML who underwent transplantation relapse, and can receive the second transplantation. There was no advantage in children patients with AML using TBI - based conditioning regimens. Conditioning regimens consisted of high - dose cytarabine, in combination with granulocyte colony - stimulating factor has advantage, and improve DFS. Unrelated umbilical cord blood has emerged as a potential option. Compared with unrelated bone marrow transplantation, there was no different in DFS and relapse. For the extent,it is one of the donor hematopoietic stem cell sources.