| Objective:The clinical data from December 2015 to December 2018 of 124 children treated with HSCT in the First Affiliated Hospital of Zhengzhou University were retrospectively summarized and analyzed.The survival condition of these children has been further studied.The evidence for clinical practice of allo-HSCT in children can be provided by analyzing and summarizing the clinical characteristics,advantage of variety transplantation schemes,and impact of multiple factors on the prognosis of these data.Methods:1.Cases data:124 pediatric allogeneic hematopoietic stem cell transplantation cases from the First Affiliated Hospital of Zhengzhou University from December 2015 to December 2018 were selected as the research objects,to investigate the effects of primary disease type,donor type,pretreatment and liver function on hematopoietic reconstruction,the occurrence and long-term survival of GvHD.2.Statistical analysis:The statistical software SPSS21.0 was used for statistical analysis.Standard deviation of sample means was used to describe the measurement data,and rate(%)was used to describe the counting data.Differences of Measurement data were analyzed by t-text,and chi-square test was used for difference analysis of counting data.Kaplan-Meier method and COX regression were used for survival analysis.P<0.05 was defined as statistically significant.Results:1.Hematopoietic reconstruction:Neutrophil implantation rate was 96.74%,and platelet implantation rate was 95.97%.There was no significant difference in hematopoietic reconstruction between children with neoplastic disease and children without neoplastic disease.The implantation rate of children with neoplastic diseases was 98.18%.The differences in the implantation time of neutrophils and platelets in MSD,UD and haploid groups were not statistically significant,while the implantation time of neutrophils and platelets in UCB transplantation was prolonged and statistically significant(P<0.05).The implantation rate of children with non-neoplastic diseases was 95.65%,and there was no statistically significant difference in the implantation time of neutrophils and platelets in MSD,UD,haploid and UCB transplantation(P>0.05).2.GvHD Occurrence:In 119 cases of children with success,a GvHD incidence was 42.02%,in which ?-? aGvHD incidence was 12.61%,and cGvHD incidence was 34.19%.The incidence of aGvHD was 45.45%,while the incidence of cGvHD was 25.45%in children with tumor diseases,and the incidence of MSD and ud-hsct cGvHD was higher and statistically significant(?2=8193,P=0.042).The aGvHD incidence was 37.68%in children with non-tumor diseases,haploid and UCBT group ?-? aGvHD incidence is higher,and compared with the other two groups was statistically significant(?2=10.083,P=0018).The incidence of cGvHD was 37.68%,and there was no statistically significant.difference among different donor types(P=0.549).3.Effects of abnormal liver function before preconditioning:Among the 119 children implanted successfully,34 cases had preconditioning liver function abnormalities.In the oncology group,there was no statistically significant increase in the time of neutrophil and platelet implantation due to abnormal liver function before pretreatment(neutrophil implantation P=0.668,platelet implantation P=0.708),and the incidence of aGvHD increased(65.2%)(P=0.012).In the non-neoplastic disease group,abnormal liver function before pretreatment resulted in prolonged implantation time,which was statistically significant(mean time of neutrophil implantation was 14.00±1.73 days,P<0.001).The mean time of platelet implantation was 33.36±8.08 days(P=0.001).And the incidence of aGvHD increased(72.7%)(P=0.013).4.Complications after transplantation:There were 3 cases of vodd(2.42%),8 cases of viral infection(6.45%),10 cases of hemorrhagic cystitis(8.06%),16 cases of pulmonary infection(12.90%)and 14 cases of skin mucosal injury(11.29%).5.Effects of different pretreatment schemes:among the four pretreatment schemes of TBI+VP16+Cy,TBI+Cy,improved BuCy and improved FBC,the children with TBI+VP16+Cy pretreatment scheme had lower OS,and the results were statistically significant(?2=9.407,P=0.03).6.Recurrence of neoplastic diseases:The recurrence rate of neoplastic diseases was 12.96%,and the median time of recurrence was 7 months(4-20 months)after transplantation.To analyze the effect of pre-transplant status on tumor recurrence,the recurrence rate of high-risk group was significantly higher than that of children in low-risk group(33.4%vs7.1%,P=0.017).The effect of different pretreatment schemes and donor types on tumor recurrence was not statistically significant(P=0.938).7.Survival:The median follow-up time of 55 children with tumor diseases was 26 months(1-45 months),the 2-year OS was 77.0%,and the 2-year EFS was 73.4%.The survival curves of lower-risk groups showed a higher OS and EFS than those of higher-risk groups(OS:Log Rank=16.569,P<0.001;EFS:Log Rank=8.906,P=0.003).However,the median follow-up time of 69 children with non-tumor diseases was 26 months(1-48 months),the 2-year OS was 92.75%,and the 2-year EFS was 89.7%.8.Risk factor analysis:For the group of cases with tumor disease group,pre-transplant disease status and primary tumor recurrence were risk factors affecting the long-term survival of children with tumor disease(P<0.05),and the relative risk(HR)were 14.289(95%CI,1.406-145.257)and 14.878(95%CI,2.428-91.186).For the non-neoplastic disease group,the time from diagnosis to transplantation was a risk factor affecting the long-term survival of children with non-neoplastic disease(P<0.05),and the relative risk(HR)was 1.405(95%CI,1.143-1.727).Conclusions:1.Abnormal liver function may affect hematopoietic reconstruction in children,prolong the implantation time,and possibly increase the incidence of aGvHD.2.Prophylactic medication against VOD,hemorrhagic cystitis,viral and fungal infections before pretreatment can reduce the incidence of the above complications.3.TBI preconditioning may have adverse effects on the long-term survival of children.4.Haploid hematopoietic stem cell transplantation had no significant effect on the long-term survival of children.5.For children with neoplastic diseases,pre-transplant disease status and primary tumor recurrence is a risk factor affecting their long-term survival.For children with non-neoplastic diseases,the time from diagnosis to transplantation is a risk factor which can affect their long-term survival.Therefore,once diagnosed with bone-marrow depleting diseases,a suitable donor should be found as soon as possible and allo-HSCT should be accepted as soon as possible. |
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