CLAG或FLAG桥接BuCy的预处理方案治疗儿童急性白血病的疗效观察

Clinical observations of the therapeutic effect of CLAG or FLAG bridging BuCy conditioning regimen in the treatment of childhood acute leukemia

目的旨在观察CLAG桥接BuCy作为预处理方案治疗儿童急性白血病的移植疗效,并与FLAG预处理方案比较。方法收集2018年8月~2020年6月行异基因造血干细胞移植(allo-HSCT)的70例急性白血病患儿临床资料,比较2种预处理方案的预处理相关毒性、造血重建、移植物抗宿主病、移植后病毒感染、复发及生存情况。结果与FLAG组相比,CLAG组EB病毒感染率(40%)相对较高(P<0.05)。2组患儿在预处理相关毒性反应、造血重建、GVHD发生及总体生存和复发方面均无差异(P>0.05)。多因素分析显示克拉屈滨和氟达拉滨2种预处理方案在患儿复发及生存方面均无差异(P>0.05),疾病类型与患儿生存显著相关(P<0.05,HR:0.088),移植前骨髓原始细胞是否≥5%及供受体HLA是否全合与患儿复发显著相关(P<0.05,HR:34.678、P<0.05,HR:0.024)。结论CLAG组在预处理相关毒性反应、造血重建、GVHD发生及总体生存和复发方面与FLAG组无明显差异,总体疗效不劣于FLAG组。

Objective To determine the therapeutic efficacy of cladribine combined with BuCy conditioning regimen for childhood acute leukemia, and compare it with fludarabine. Methods The clinical data of 70 children with acute leukemias who underwent all-HSCT from August 2018 to June 2020 were collected. The data of pretreatment-related toxicity, hematopoietic reconstitution, graft-versus-host disease, virus infection, relapsed and survival between CLAG and FLAG group were statistically analyzed. Results EBV infection in CLAG group was significantly more than that in FLAG group(P<0.05). There was no significant difference in RRTs, hematopoietic reconstitution, GVHD occurrence, OS and relapsed between CLAG group and FLAG group(P>0.05). Multivariate analysis showed that there was no significant difference in the effect of conditioning regimen on relapsed and survival. Among other risk factors, types of diseases were significantly correlated with OS(P<0.05, HR:0.088). Relapse was significantly correlated with bone marrow morphological remission before transplantation and the matching degree of donor and recipient HLA(P<0.05,HR:34.678;P<0.05,HR:0.024). Conclusion There was no significant difference in RRTs, hematopoietic reconstitution, GVHD occurrence, OS and relapsed between CLAG group and FLAG group. The overall efficacy of CLAG group was not inferior to FLAG group.