Haplotype allogeneic hematopoietic stem cell transplantation for refractory and relapsed childhood leukemia / 中华器官移植杂志

ABSTRACT

Objective To explore the effect and feasibility of haplotype allogeneic hematopoietic stem cell transplantation (allo-HSCT) used in the childhood patients with refractory and relapsed leukemia.Methods Thirty children with refractory and relapsed leukemia received haplotype allo-HSCT from June 2007 to June 2011 in Beijing Military General Hospital,including 14 cases of acute myeloid leukemia (AML) and 16 cases of acute lymphoblastic leukemia (ALL).Of the 30 cases,there were 11 cases of initial recurrence,16 cases of second or more relapse,and 3 cases of primary refractory leukemia.The bone marrow and peripheral blood of donors were used for transplantation.All children were subjected to pretreatment consisting of cytarabine,busulfan,fludarabine and total body irradiation (TBI),etc.Graft-versus-host disease (GVHD) was prevented by combining variety of immunosuppressants including Cyclosporin A (CsA),Methotrexate (MTX),Mycophenolate mofetil (MMF) and anti-thymocyte immunoglobulin (ATG),etc.The regimen-associated side effect incidence of GVHD and disease-free survival probabilities were observed after HSCT.Results The results showed that all of the 30 children acquired hematopoietic reconstitution,and the median time of granulocytes exceeding 0.5 × 109/L and platelets exceeding 20 × 109/L which were transplanted 100％ by donors was 18.5 days and 24.2 days respectively.The mean follow-up period was 22.5 months (3 ～48 months).Twelve children had experience of acute GVHD,and 6 children had experience of chronic GVHD.Four children died of GVHD,3 died of infection and 6 died of relapse,and the rest children were alive in free situation.The 2-year disease-free survival rate was 55％.Conclusion Haplotype allo-HSCT was an safe and feasible therapy for the childhood patients with refractory and relapsed leukemia.