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
收稿日期: 2022-11-29
网络出版日期: 2023-03-10
Prevention and treatment of relapse after hematopoietic stem cell transplantation in children with acute myeloid leukemia
Received date: 2022-11-29
Online published: 2023-03-10
急性髓系白血病约占儿童白血病的15%~20%，规范化疗后仍有近40%的儿童复发，异基因造血干细胞移植是预防其复发的强有力手段，但仍有部分患者复发，此类患者2年的总生存率不足20%，部分复发患者无法耐受传统化疗或对化疗不敏感。复发是移植后死亡的主要原因，因此预防移植后复发应该着手于移植前，优化移植链条的各个环节，严格随访监测。近年来新涌现的分子靶向药物、新型免疫治疗、CRISPR基因编辑造血干细胞疗法等也为移植后复发的儿童患者提供了更多的治疗策略。文章根据移植链条的流程，总结了各环节的预防措施及移植后复发的治疗选择，以期为临床提供方向和策略。
赵明一 , 李嘉华 , 江华 . 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[J]. 临床儿科杂志, 2023 , 41(3) : 167 -174 . DOI: 10.12372/jcp.2022.22e1591
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.
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