Гаплоидентичная трансплантация гемопоэтических стволовых клеток у детей с острыми миелоидными лейкозами: эволюция метода и собственные данные

Н.Н. Субботина, И.С. Долгополов, А.В. Попа, В.К. Бояршинов, Р.И. Пименов, Г.Л. Менткевич

НИИ детской онкологии и гематологии ФГБУ «РОНЦ им. Н.Н. Блохина» РАМН, Москва, Российская Федерация


РЕФЕРАТ

В настоящей работе представлены результаты проведения гаплоидентичной трансплантации гемопоэтических стволовых клеток (гаплоТГСК) детям с острыми миелоидными лейкозами (ОМЛ) крайне неблагоприятного прогноза. В исследование включено 18 пациентов в возрасте 1–18 лет. Статус заболевания на момент трансплантации: ОМЛ высокого риска в первой ремиссии (n = 4, 22 %), более двух ремиссий (n = 7, 39 %), не в ремиссии (n = 4, 22 %), вторичный ОМЛ в ремиссии (n = 3, 17 %). Всем пациентам был проведен немиелоаблативный режим кондиционирования с последующей гаплоТГСК от гаплоидентичных доноров. За счет донорского материала показатели крови восстановились у 17 из 18 пациентов: лейкоциты — в среднем на 11-й день, тромбоциты — на 12-й. От прогрессирования заболевания и инфекции без признаков восстановления кроветворения умерла 1 больная из группы «не в ремиссии на момент гаплоТГСК». Токсические проявления режима были незначительными. Острая реакция «трансплантат против хозяина» I–II степени отмечена у 88 % пациентов, III степени — у 6 %. Проявления хронической реакции «трансплантат против хозяина» наблюдались у 85 % реципиентов, у 1 больной — в тяжелой форме. Причины смертности: инфекция (n = 2, 11 %), рецидив/прогрессирование опухоли (n = 5, 28 %). Остаются под наблюдением без признаков заболевания 11 (61 %) пациентов. При среднем сроке наблюдения 84 мес. (диапазон 1–144 мес.) бессобытийная выживаемость равна 57,5 % Трансплантационная летальность составила 13,3 % при среднем сроке наблюдения 124 мес.


Ключевые слова: острые миелоидные лейкозы у детей, неблагоприятный прогноз, гаплоидентичная трансплантация гемопоэтических стволовых клеток.

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