Age Analysis Of Survival Rate And Complications After Hematopoietic Stem Cell Transplantation In Children With Thalassemia

Thalassemias are dominant hereditary hemolytic anemias.Based on the deleted or defected gene,they can be categorized into the following types:a-thalassemia,?-thalassemia,?-thalassemia,y-thalassemia and other rare thalassemias.Among them,severe ?-thalassemia is a type of thalassemia that poses a serious threat to patients'life and their quality of life.Allogeneic hematopoietic stem cell transplantation has become the only available method to treat blood transfusion-dependent thalassemias,and has been widely used in the world.Allogeneic hematopoietic stem cell transplantation primarily poses the risk of graft-versus-host disease,hepatic venous occlusion,infection,bleeding,transplantation failure and other complications.According to most of foreign literature,it is obvious that among older children,a variety of blood or tumor disorders have poor prognosis.Adolescents are considered to be a high-risk group by pediatricians,and have long been regarded as high-risk patients by adult hematologists.Among the children who had ?-thalassemia and were treated with hematopoietic stem cell transplantation in the Pediatrics Department of the Southern Hospital of Southern Medical University,we had been collecting the data of 332 valid ?-thalassemia cases,281 identical ?-thalassemia cases and 51 haploidentical ?-thalassemia cases from January 1st,2012 to June 30th,2018;we had been following up the cases until September 30th,2018.Based on the age of the children patients,the case data was divided into three groups for discussion and comparison:group 1 for the age of less than or equal to 4 years,group 2 for the age of 5 years to 8 years and group 3 for the age of over 8 years.For the three age groups,the incidence of graft-versus-host disease,acute graft-versus-host disease and chronic graft-versus-host disease was analyzed.In addition,the correlation between the age and the incidence of grade ?&?,? and ? acute graft-versus-host diseases was examined,together with the analysis of age specific incidence graphs.Also,the correlation between the age and the incidence of infection,oral infection,pulmonary infection,septicemia convulsion,virus infection,cytomegalovirus infection,EB virus infection,herpes simplex ? and ? diseases,varicella virus infection,HHV-6 infection,post-transplant implantation and other complications was examined for the three age groups.Furthermore,the survival curves of the survival rates and the disease-free survival rates of all age groups were studied.SPSS 20.0 statistical software was used to analyze the incidence of acute GVHD,grade ?&? acute GVHD,grade ? acute GVHD,grade ? acute GVHD and chronic GVHD.The resulting data of the incidence and analysis graphs were tested by Kaplan-Meier estimator(P<0.05 is considered statistically significant).The data of OS and ESF was also analyzed by Kaplan-Meier estimator,while the total GVHD incidence and the rest incidences were tested by x2 test(P<0.05 is considered statistically significant).In full-matched cases,the age correlated with OS,ESF,and the incidence of graft-versus-host disease,chronic graft-versus-host disease,grade ?&? acute graft-versus-host disease,convulsion,oral infection and EB virus infection(P<0.05).In particular,the incidence of children aged over 8 years was significantly higher than that of children aged under 8 years.In half-matched cases,the incidence of grade ?&? acute graft-versus-host disease and EB virus infection correlated with the age.In the full-matched cases of septicemia,the incidence of Gram-negative bacteria was higher than that of Gram-positive bacteria(55.56%vs.37.78%)..In terms of the treatment of septicemia,carbapenems can be selected for early treatment,with the selective use of positive bacteria sensitive drugs.Benzodiazepines are recommended as a major medicine for treating convulsions in children,while diprivan should be used in patients with refractory epilepsy.However,the drug treatment effective in treating viral infection has great limitations.For children thalassemia patients who have received a transplant,especially among older children,more attention should be paid to conduct timely diagnosis and treatment of graft-versus-host disease,convulsion,infection and so on.