重型再生障碍性贫血儿童接受异基因造血干细胞移植前铁过载对疗效影响的临床研究

Clinical analysis on the impact of pretransplant iron overload on allogeneic hematopoietic stem cell transplantation for patients with acquired severe aplastic anemia in pediatric

探讨铁过载对治疗重型再生障碍性贫血(SAA)患儿异基因造血干细胞移植(allo-HSCT)疗效的影响。通过对武汉儿童医院血液科2018年1月至2022年8月间接受allo-HSCT的74例SAA患儿的临床资料进行回顾性分析,发现移植前铁过载组[血清铁蛋白(SF)>1000μg/L]患儿移植前病程更长、红细胞输注量更大、回输CD34^(+)细胞数更多,且铁过载显著延迟了移植后调节性T细胞(Treg细胞)的重建,增加了移植后出血性膀胱炎和Ⅲ~Ⅳ度急性移植物抗宿主病的发生率。然而,铁过载对患儿的总生存率和无失败生存率并无显著影响。

This study aimed to investigate the effect of iron overload on the transplant outcomes of pediatric patients with severe aplastic anemia(SAA)undergoing allogeneic hematopoietic stem cell transplantation(allo-HSCT).A retrospective analysis was conducted on the clinical data of 74 children with SAA who received allo-HSCT at the Hematology Department of Wuhan Children’s Hospital between January 2018 and August 2022.Children with iron overload(serum ferritin>1000μg/L)before transplantation had a longer disease course,received more red blood cell transfusions,and had a higher number of CD34^(+) cells infused.Moreover,iron overload significantly delayed the reconstitution of regulatory T cells after transplantation,increasing the incidence of hemorrhagic cystitis and gradeⅢ-Ⅳacute graft-versus-host disease after transplantation.However,iron overload did not significantly affect the overall survival and failure-free survival rates of the children.