儿童急性髓系白血病造血干细胞移植后复发的预防和治疗

doi:10.12372/jcp.2022.22e1591

Abstract

Abstract:

Acute myeloid leukemia accounts for about 15%-20% of childhood leukemia, and nearly 40% of pediatric patients still relapse after standard chemotherapy. Allogeneic hematopoietic stem cell transplantation is a powerful means to prevent its recurrence. However, some patients still relapse, and the 2-year survival rate of these patients is less than 20%. Some patients with relapse cannot tolerate or are insensitive to conventional chemotherapy. Recurrence is the main cause of death after transplantation. The prevention of relapse after transplantation ought to start before transplantation, optimize each part of the transplantation chain, and strictly follow the follow-up monitoring. In recent years, new molecular targeted drugs, new immunotherapy and CRISPR genome-edited hematopoietic stem cell therapy have also provided more treatment strategies for pediatric patients with AML relapse after transplantation. According to the procedure of transplantation chain, this paper summarized the preventive measures of each link and the treatment options of post-transplantation recurrence, in order to provide the direction and strategy for the clinic.

Key words: acute myeloid leukemia, hematopoietic stem cell transplantation, relapse, child

ZHAO Mingyi, LI Jiahua, JIANG Hua. Prevention and treatment of relapse after hematopoietic stem cell transplantation in children with acute myeloid leukemia[J].Journal of Clinical Pediatrics, 2023, 41(3): 167-174.

Figures/Tables 2

References 50

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预处理方案	药物	剂量	用药时机	供者类型	文献
Clo/Flu/Bu	Clo Flu Bu（iv）或ATG	30 mg·m^-2·d^-1 10 mg·m^-2·d^-1 AUC=85~95 mg·h^-1·L^-1 6 mg·kg^-1（>40 kg）	－5 d to －2 d －5 d to －2 d / －9 d to －6 d	allo-HSCT	Versluijs等^[17]
TBI/Flu/Cy	TBI Flu Cy	333 cGy 25 mg·m^-2·d^-1 60 mg·m^-2·d^-1	－7 d to －5 d －4 d to －2 d －3 d，－2 d	CB-HSCT	Cho 等^[46]
Bu/Cy/ATG	Bu Cy ATG	3.2~4.8 mg·kg^-1·d^-1 40~60 mg·kg^-1·d^-1 8~10 mg·kg^-1·d^-1 or 10~15 mg·kg^-1·d^-1	－8 d to －6 d －5 d to －4 d －5 d to －2 d －3 d to －1 d	MUD, HID, MSD-HSCT	罗荣牡，等^[47]
Ara-C/Bu/Cy/CCNU	Ara-C Bu Cy CCNU	4 g·m^-2·d^-1 3.2 g·m^-2·d^-1 1.8 g·m^-2·d^-1 250 mg·m^-2·d^-1	－10 d to －9 d －8 d to －6 d －5 d to －4 d －1 d	MUD-HSCT	贾晨光，等^[48]
treosulfan/Flu/TBI	treosulfan Flu TBI	10~14 mg·m^-2·d^-1 30 mg·m^-2·d^-1 200 cGy	－6 d to －4 d －6 d to －2 d －1 d	allo-HSCT	Beelen等^[49]
Bu/Cy/Mel	Bu Cy Mel	3.2~4.8 mg·kg^-1 60 mg·kg^-1 140 mg·m^-2	－7 d to －4 d －3 d，－2 d －1 d	MUD, MSD-HSCT	Sauer等^[50]

Prevention and treatment of relapse after hematopoietic stem cell transplantation in children with acute myeloid leukemia

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