Clinical Study On The Efficacy And Common Complications Of Allogeneic Hematopoietic Stem Cell Transplantation In Pediatric Hematopathy

ObjectiveTo analyze the efficacy of allogeneic hematopoietic stem cell transplantation for children with hematologic diseases,and to analyze the clinical characteristics of common complications after hematopoietic stem cell transplantation,related risk factors and their relationship with survival,so as to improve the success rate of transplantation and improve the prognosis of children.MethodsThe clinical data of children who received allo-HSCT in the Affiliated Hospital of Qingdao University from January 2016 to December 2020 were retrospectively analyzed,including 19 cases of aplastic anemia(AA),4 cases of acute lymphoblastic leukemia(ALL),and 10 cases of acute myeloid leukemia(AML),a total of 33 cases.To compare the relationship between different primary diseases,transplantation types and the occurrence of complications and survival,and to look for possible factors that affect the success rate of transplantation and survival.Results1.By the end of the follow-up on December 31,2020,33 cases of children received Allo-HSCT,including 16 males and 17 females,aged 2-13 years old,with a median age of 7 years old.There were 19 cases of AA,10 cases of AML and 4 cases of ALL.According to disease type,they were divided into AA group and AL group,including 19 cases in AA group and 14 cases in AL group.Transplantation types: 16 unrelated donors and 17 consanguineous donors;There were 18 cases of complete compatibility and 5cases of incomplete compatibility.There were 26 cases of peripheral blood stem cell transplantation and 7 cases of bone marrow + peripheral blood stem cell transplantation.There were 24 cases of ABO blood group congruence,6 cases of ABO blood group major side incompatibility and 3 cases of ABO blood group minor side incompatibility.There were 13 cases of complete compatibility from unrelated donors,3 cases of incomplete compatibility from unrelated donors,5 cases of complete compatibility from consenting donors,and 12 cases of haploid transplantation.2.As of December 31,2020,the median follow-up time of the 33 cases was 20months(1-52 months),and the mean survival time after transplantation was 21.36 months(1-52 months).The overall survival rate(OS)was 84.8%.7 cases(21.2%)relapsed and 5cases(15.2%)died,including 3 cases(60.0%)relapsed and death,all of which were in the AL group.There were 2 transplant-related deaths(30.0%),1 in AA group and 1 in AL group.Although the mortality rate of AA group was lower than that of AL group,there was no statistically significant difference between the two groups(P=0.089).The OS of AA group was 94.7%.One patient(5.3%)died,and analysis found that transplants from unrelated donors had better survival(P=0.025).There were 14 cases in AL group.After transplantation,all implantation was successful and hematopoietic reconstruction was performed.The OS was 71.4%,and 7 cases(50.0%)relapsed,all of which were hematologic relapses,among which 1 case first developed molecular biological relapses after transplantation and later developed hematologic relapses.Of all the recurrent children,4 cases(57.1%)occurred within 100 days after transplantation,2 cases(28.6%)within 100 days to 1 year,and 1 case(14.3%)within 1 to 2 years after transplantation.Four cases(28.6%)died.The analysis found that BM+PBSC transplantation had a higher survival rate(P=0.010).3.Complications: GVHD occurred in 10 of the included patients.In the AA group,GVHD occurred in 5 cases(26.3%),including 2 cases of grade I,2 cases of grade II,and1 case of c GVHD.In the AL group,GVHD occurred in 5 patients(35.7%),including 1case of grade I,3 cases of grade II,and 1 case of grade IV.Univariate analysis showed that gender was associated with GVHD,and male was more than female.Poor graft function(PGF)was 2 cases(6.06%),primary PGF and secondary PGF were 1 cases(50.0%).Reversible posterior encephalopathy syndrome(PRES)was found in 6 patients(18.2%).In addition,there was 1 case of syndrome of inappropriate antidiuretic hormone secretion(SIADH)and 1 case of engraftment syndrome(ES).Conclusions1.Allo-HSCT is an effective method for the treatment of children’s blood diseases.In AL,for the children with high risk of recurrence,we seize the opportunity of transplantation and select appropriate donors to overcome the recurrence problem of the children with MRD positive,improve the efficacy of the patients with recurrence,and thus overcome the bottleneck of chemotherapy for leukemia.In this study,the OS of AL group was 71.4%,but the problem of recurrence after transplantation needs more attention and more studies to solve it.For SAA-I,while actively controlling infection,the donor should be actively sought.If there is a suitable donor,HSCT is the first choice.At the same time,SAA-II should be transplanted more actively if possible.In this study,OS in AA group was as high as 94.7%,and only 1 patient developed primary PGF.Transplantation can greatly improve the efficacy of SAA.2.To explore the influencing factors of each link in the process of transplantation,especially the selection of donor,is of great importance for the prognosis of transplant patients.In this study,the HLA partially mismatched of the vast majority of conditions,only 1 case of a GVHD of IV degree,at the same time in 6 patients with PRES,5 patients prognosis is good,not from any neurological sequelae,confirming HSCT can be a means for the treatment of blood safety,but the premise is to complications after transplantation,to be found in a timely and reasonable and effective treatment.Thus transplantation can be truly an effective and safe treatment for blood diseases.