贝林妥欧单抗治疗儿童复发急性B淋巴细胞白血病3例临床分析

Clinical analysis of three relapsed B-cell acute lymphoblastic leukemia children treated with blinatumomab

目的观察贝林妥欧单抗治疗儿童复发B淋巴细胞白血病(B-ALL)的疗效和安全性。方法回顾性分析贝林妥欧单抗治疗3例急性B淋巴细胞白血病复发儿童的病例资料,总结诊治经验。结果3例均为B-ALL在化疗或嵌合抗原受体T细胞免疫治疗后复发的男性患儿。贝林妥欧单抗从5μg/(m^(2)·d)逐渐爬坡达到最大剂量15μg/(m^(2)·d),平均15d后骨髓完全缓解(CR),且微小残留病灶(MRD)均<1×10^(-4)。治疗过程中患儿出现不同程度的发热、肝功能异常、水肿、尿酸升高和血钾降低,经对症处理后均好转。结论贝林妥欧单抗治疗儿童复发B-ALL缓解率高;剂量爬坡治疗方式可改善患儿耐受性,严重不良反应少且可控。贝林妥欧单抗治疗儿童复发B-ALL的疗效和安全性仍需要更多临床研究提供证据。

Objective To observe the efficacy and safety of blinatumomab in the treatment of children with relapsed B-cell acute lymphocytic leukemia(B-ALL).Methods Clinical data of 3 relapsed B-ALL children treated with blinatumomab were analyzed retrospectively,the diagnosis and treatment experience were summarized.Results All three cases were male children with B-ALL relapsed after chemotherapy or chimeric antigen receptor T-cell(CAR-T)immunotherapy.The dosage of Blinatumomab increased gradually from 5μg/(m^(2)·d)to the maximum dose of 15μg/(m^(2)·d).After an average of 15 days,all cases achieved bone marrow complete remission(CR)and the minimal residual lesions(MRD)were all<1×10^(-4).During the treatment,all cases had different degrees of fever,abnormal liver function,edema,elevated uric acid and decreased potassium,which were improved after symptomatic treatment.Conclusions The remission rate of relapsed B-ALL in children treated with blinatumomab is high;dose creeping treatment improves the tolerance of the children,and the serious adverse effects are few and manageable.The efficacy and safety of blinatumomab in the treatment of recurrent B-ALL in children still need more clinical studies to provide evidence.