供体淋巴细胞输注预防和治疗儿童异基因造血干细胞移植后恶性血液病复发。

IF 1.9 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Journal of the Chinese Medical Association Pub Date : 2023-11-01 Epub Date: 2023-09-12 DOI:10.1097/JCMA.0000000000000992
Ming-Hsin Hou, Chih-Ying Lee, Cheng-Yin Ho, Ting-Yen Yu, Giun-Yi Hung, Fang-Liang Huang, Tzeon-Jye Chiou, Chun-Yu Liu, Hsiu-Ju Yen
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引用次数: 0

摘要

背景:供体淋巴细胞输注(DLI)是治疗异基因造血干细胞移植(HSCT)后血液系统恶性肿瘤的有效方法。然而,很少有研究探讨其在儿科人群中的最佳使用。在此,我们报告了DLI的单中心经验和预测其结果的因素。方法:这项回顾性研究包括在异基因HSCT后接受DLI(1998年6月至2022年12月)的儿童患者。收集有关患者特征、先发制人的DLI疾病状态和DLI特征的数据。主要结果是总生存率(OS)、无事件生存率(EFS)和移植物抗宿主病(GVHD)的发展。结果:研究队列包括17名急性白血病患者、3名慢性白血病患者和3名淋巴瘤患者。预防性、先发制人和治疗性DLI分别用于7名、7名和9名患者。患者的中位年龄和DLI剂量分别为9岁和4.6 × 10 7个CD3+细胞/kg。5年OS、EFS和非复发死亡率分别为43.5%、38.3%和13.3%。约39%的患者出现III级或IV级急性移植物抗宿主病,而30%的可评估患者出现中度/重度慢性移植物抗逆转录病毒(cGVHD)。患者在HSCT前的疾病状况(p=0.009)和DLI(p=0.018)是影响EFS的关键因素。剂量递增计划的实施与中度/重度cGVHD风险的边际降低有关(p=0.051)。DLI剂量≥5 × 10 7 CD3+细胞/kg与cGVHD的高-中-重度风险(p=0.002)和OS降低(p=0.089)显著相关。结论:患者在HSCT和DLI前的疾病状态可能有助于预测EFS。DLI作为一种预防性和先发制人的方式,可获得良好的5年EFS。为了在儿童中安全地提供DLI,临床医生必须保持警惕的监测,并在将剂量增加到≥5时提前为患者做好准备 × 10 7个CD3+细胞/kg。
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Donor lymphocyte infusion for prophylaxis and treatment of relapse in pediatric hematologic malignancies after allogeneic hematopoietic stem cell transplant.

Background: Donor lymphocyte infusion (DLI) is effective for managing patients with hematologic malignancies after allogeneic hematopoietic stem cell transplant (HSCT). However, few studies have explored its optimal use in pediatric populations. Herein, we report our single-center experiences of DLI and factors for predicting its outcomes.

Methods: This retrospective study included pediatric patients who had received DLI (between June 1998 and December 2022) after allogeneic HSCT. Data regarding patient characteristics, preemptive DLI disease status, and DLI characteristics were collected. The primary outcomes were overall survival (OS), event-free survival (EFS), and graft-vs-host-disease (GVHD) development.

Results: The study cohort comprised 17 patients with acute leukemia, 3 with chronic leukemia, and 3 with lymphoma. Prophylactic, preemptive, and therapeutic DLI were used in seven, seven, and nine patients, respectively. Patients' median age and DLI dose were 9 years and 4.6 × 10 7 CD3 + cells/kg, respectively. The 5-year OS, EFS, and nonrelapse mortality were 43.5%, 38.3%, and 13.3%, respectively. Approximately 39% of the patients developed grade III or IV acute GVHD, whereas moderate/severe chronic GVHD (cGVHD) occurred in 30% of the evaluable patients. Patients' disease status before HSCT ( p = 0.009) and DLI ( p = 0.018) were the key factors influencing EFS. The implementation of a dose escalation schedule was associated with a marginal reduction in the risk of moderate/severe cGVHD ( p = 0.051). A DLI dose of ≥5 × 10 7 CD3 + cells/kg was significantly associated with a high moderate to severe cGVHD risk ( p = 0.002) and reduced OS ( p = 0.089).

Conclusion: Patients' disease status before HSCT and DLI may help predict EFS. The use of DLI as a prophylactic and preemptive modality leads to a favorable 5-year EFS. To safely deliver DLI in children, clinicians must maintain vigilant monitoring and prepare patients in advance when escalating the dose to ≥5 × 10 7 CD3 + cells/kg.

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来源期刊
Journal of the Chinese Medical Association
Journal of the Chinese Medical Association MEDICINE, GENERAL & INTERNAL-
CiteScore
6.20
自引率
13.30%
发文量
320
审稿时长
15.5 weeks
期刊介绍: Journal of the Chinese Medical Association, previously known as the Chinese Medical Journal (Taipei), has a long history of publishing scientific papers and has continuously made substantial contribution in the understanding and progress of a broad range of biomedical sciences. It is published monthly by Wolters Kluwer Health and indexed in Science Citation Index Expanded (SCIE), MEDLINE®, Index Medicus, EMBASE, CAB Abstracts, Sociedad Iberoamericana de Informacion Cientifica (SIIC) Data Bases, ScienceDirect, Scopus and Global Health. JCMA is the official and open access journal of the Chinese Medical Association, Taipei, Taiwan, Republic of China and is an international forum for scholarly reports in medicine, surgery, dentistry and basic research in biomedical science. As a vehicle of communication and education among physicians and scientists, the journal is open to the use of diverse methodological approaches. Reports of professional practice will need to demonstrate academic robustness and scientific rigor. Outstanding scholars are invited to give their update reviews on the perspectives of the evidence-based science in the related research field. Article types accepted include review articles, original articles, case reports, brief communications and letters to the editor
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