第一次同种异体移植后儿童急性白血病复发的第二次半相合造血干细胞移植的结果和预测因素
Outcomes and predictors of second haploidentical hematopoietic stem cell transplantation for pediatric acute leukemia relapsing after a first allograft.
摘要(中文译文)
对于首次异基因造血干细胞移植（allo-HSCT）后复发的急性白血病（AL）患儿，采用单倍体造血干细胞移植（haplo-HSCT）作为挽救治疗的临床疗效及预后因素尚不明确。本研究旨在评估既往接受过allo-HSCT后复发的AL患儿接受第二次单倍体造血干细胞移植的临床疗效、生存结局及预后因素。本回顾性研究纳入2017年1月至2023年12月期间在中国两家移植中心接受第二次haplo-HSCT的40例儿科患者（中位年龄：8.5岁）。主要终点为总生存期（OS）和无白血病生存期（LFS）；次要终点包括累积复发率和非复发死亡率（NRM）。中位随访16.0个月，1年和2年OS率分别为77.8%和65.5%，LFS率分别为72.4%和61.0%。2年累积复发率和NRM分别为26.6%和15.1%。多因素分析显示，B细胞急性淋巴细胞白血病与最有利的2年OS相关（HR=0.081，95%CI：0.007-0.877，P=0.039）。III-IV级急性GVHD发生率为25.0%，慢性GVHD发生率为50.0%（其中广泛型为10.0%）。这些研究结果表明，对于缺乏相合供者的复发AL儿科患者，采用清髓性预处理的第二次haplo-HSCT可能是一种可行且有效的挽救治疗选择，其作用可能通过移植物抗白血病效应实现。未来研究应结合靶向治疗和免疫调节策略以改善这一高危人群的结局。
Abstract
The clinical efficacy and prognostic factors of haploidentical hematopoietic stem cell transplantation (haplo-HSCT) as a salvage approach for children with relapsed acute leukemia (AL) after a first allogeneic HSCT (allo-HSCT) remain unclear. This study aimed to evaluate the clinical efficacy, survival outcomes, and prognostic factors of second haploidentical HSCT in children with relapsed AL following prior allo-HSCT. This retrospective study included 40 pediatric patients (median age: 8.5 years) who underwent a second haplo-HSCT at two Chinese transplantation centers between January 2017 and December 2023. The primary endpoints were overall survival (OS) and leukemia-free survival (LFS); and secondary endpoints included cumulative relapse incidence and non-relapse mortality (NRM). With a median follow-up of 16.0 months, 1- and 2-year OS rates were 77.8% and 65.5%, and LFS rates were 72.4% and 61.0%, respectively. The 2-year cumulative incidences of relapse and NRM were 26.6% and 15.1%, respectively. Multivariate analysis showed that B-cell acute lymphoblastic leukemia was associated with the most favorable 2-year OS (HR = 0.081, 95%CI: 0.007-0.877, P = 0.039). Grade III-IV acute GVHD occurred in 25.0% of patients, and chronic GVHD occurred in 50.0% (10.0% extensive). These findings suggest that second haplo-HSCT with myeloablative conditioning may be a viable and effective salvage option for pediatric patients with relapsed AL lacking matched donors, possibly through graft-versus-leukemia effects. Future studies should incorporate targeted therapies and immune modulation strategies to improve outcomes in this high-risk population.
如何引用
AMA
Kai Chen, Huifang Wang, Qing Liu, Guanhua Hu, Zhang Feng, Bing Zou, et al. Outcomes and predictors of second haploidentical hematopoietic stem cell transplantation for pediatric acute leukemia relapsing after a first allograft.. Frontiers in immunology. 2026; doi:10.3389/fimmu.2026.1885224.
APA
Kai Chen, Huifang Wang, Qing Liu, Guanhua Hu, Zhang Feng, Bing Zou, et al (2026). Outcomes and predictors of second haploidentical hematopoietic stem cell transplantation for pediatric acute leukemia relapsing after a first allograft.. Frontiers in immunology. https://doi.org/10.3389/fimmu.2026.1885224
GB/T 7714
Kai Chen, Huifang Wang, Qing Liu, Guanhua Hu, Zhang Feng, Bing Zou, et al. Outcomes and predictors of second haploidentical hematopoietic stem cell transplantation for pediatric acute leukemia relapsing after a first allograft.[J]. Frontiers in immunology, 2026 doi:10.3389/fimmu.2026.1885224.
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