异基因造血干细胞移植治疗儿童白血病87例临床分析

Clinical Analysis of 87 Cases of Childhood Leukemia Treated with Hematopoietic Stem Cell Transplantation

目的:评估异基因造血干细胞移植(allogeneic hematopoieticstemcell transplantation,Allo-HSCT)治疗儿童急慢性白血病的效果及相关影响因素。方法:回顾性分析我科2006年2月至2012年2月间,采用Allo-HSCT治疗儿童急慢性白血病87例临床资料,按照白血病类型分为BCR/ABL+ALL、BCR/ABL-ALL、AML、CML组,通过单因素分析和多因素分析考察白血病类型、移植前状态、是否服用伊马替尼治疗和干细胞源等因素对Allo-HSCT治疗效果的影响。结果:所有入组白血病患儿接受Allo-HSCT治疗后,整体生存率(overall survival,OS)59.7%。单因素分析结果显示白血病类型(P=0.023)、a GVHD、服用伊马替尼、移植前状态(P=0.025)和干细胞来源(P=0.003)对患者的整体生存率影响具有统计学意义。多因素分析结果显示干细胞源(PBSC、UCB、BM、BM+PBSC、BM/PBSC+UCB,P=0.046)、移植前状态(CR1、CR2、CR3、NR,P=0.048)和移植种类(同胞、非亲缘、单倍体,P=0.023)能够显著影响OS;而疾病类型(ALL、AML、CML,P=0.083)、性别(P=0.968)、年龄(P=0.847)与生存率关系没有统计学意义。结论:白血病类型、移植种类、a GVHD、干细胞源、是否服用伊马替尼和移植前状态是影响异基因造血干细胞移植治疗小儿白血病疗效的关键因素。

Objective： To evaluate the effect of allogeneic hematopoietic stem cell transplantation（Allo-HSCT） for children with leukemia and investigate its related influence factors. Methods： The clinical data of 87 patients with leukemia underwent HSCT at a median age of 8 years from February 2006 to December 2013 in our centerwere retrospectively analyzed, these patients were divided into BCR/ABL＋ ALL, BCR/ABL- ALL, AML and CML groups according to Leukemia types. Results： The estimated 5-year overall survival（OS） was 59.7 % in total. Single factor analysis showed leukemia types（P=0.023）, imatinib（P=0.008）, a GVHD（P=0.001）, status before transplantation（P=0.025）, stem cell source（P=0.003） had significant impact on the overall survival. Multivariate analysis showed stem cell source（P=0.046）, status before transplantation（P=0.048） and the transplant types（P=0.023） had significant impact on OS significantly while age, sex and leukemia types had no obvious impact OS. Conclusions： The leukemia types, imatinib, a GVHD, status before transplantation, stem cell source and transplant type were key influence factors of Allo-HSCT for pediatric leukemia.