Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 급성 백혈병 환자에서 주조직적합항원 일치 부모자식간 조혈모세포 이식 후 임상경과

Clinical outcomes of hematopoietic stem cell transplantation from HLA-matched parental donor in childhood acute leukemia

  • 차은영 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이문희 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이재욱 (가톨릭대학교 의과대학 소아과학교실) ;
  • 권영주 (가톨릭대학교 의과대학 소아과학교실) ;
  • 이대형 (한림대학교 의과대학 소아과학교실) ;
  • 박영실 (경희대학교 의과대학 소아과학 교실) ;
  • 정낙균 (가톨릭대학교 의과대학 소아과학교실) ;
  • 정대철 (가톨릭대학교 의과대학 소아과학교실) ;
  • 조빈 (가톨릭대학교 의과대학 소아과학교실) ;
  • 김학기 (가톨릭대학교 의과대학 소아과학교실)
  • Cha, Eun Young (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Moon Hee (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Jae Wook (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kwon, Young Joo (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Lee, Dae Hyoung (Department of Pediatrics, College of Medicine, Hallym University) ;
  • Park, Young-Shil (Department of Pediatrics, College of Medicine, Kyung Hee University) ;
  • Chung, Nak Gyun (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Jeong, Dae Chul (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Cho, Bin (Department of Pediatrics, College of Medicine, The Catholic University of Korea) ;
  • Kim, Hack Ki (Department of Pediatrics, College of Medicine, The Catholic University of Korea)
  • 투고 : 2007.09.10
  • 심사 : 2007.10.10
  • 발행 : 2008.01.15
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초록

목 적 : 본 연구는 HLA가 일치하는 부모로부터 동종조혈모세포이식을 시행받은 소아의 이식 결과를 분석하고자 하였다. 방 법 : 1999년 4월부터 2005년 10월까지 성모병원 조혈모세포이식센터에서 급성 백혈병으로 1차 관해 후 HLA가 일치된 부모로부터 조혈모세포이식을 시행받은 환아 7명(급성 림프모구성백혈병 4명, 급성 골수성백혈병 3명)을 대상으로 하였다. 이식 시 중앙연령은 5세(범위, 1-11세; 남아 2명, 여아 5명), 공여자의 중앙연령은 35세(범위, 30-41세; 남자 5명, 여자 2명)이었다. 이식 후 대상 환아의 생착, 급성이식편대숙주병, 만성이식편대숙주병, 이식관련 사망, 재발, 이식관련 합병증과 생존율 등을 분석하였다. 결 과 : 이식부터 마지막 추적관찰까지 중앙기간이 69.5개월(범위, 18.8-96.5개월)이었다. 이식을 받은 7명의 환아들은 모두 생착이 되었고 호중구와 혈소판의 생착은 이식 후 각각 11일(범위, 10-16일)과 26일(범위, 13-39일)이었다. Grade II의 급성 이식편대숙주병은 3명(43%), grade III의 급성 이식편대숙주병은 1명(14%)에서 발생하였다. 광범위 만성이식편대숙주병은 2명(28%), 제한적 만성이식편대숙주병은 1명(14%)에서 발생하였다. 이식 후 재발은 1명(14%)이었고 이식관련 사망은 1명(14%)이었다. 대상 환아의 이식 후 5년 전체 생존율은 $83{\pm}15%$이었다. 결 론 : 소아 급성 백혈병에서 HLA가 일치하는 부모자식간 동종조혈모세포이식의 결과는 HLA가 일치하는 형제간 조혈모세포이식의 결과와 비견할 수 있으며 동종조혈모세포이식이 필요한 환아에서 형제뿐만이 아니라 부모의 HLA를 검사하면 조혈모세포 공여자 선정의 가능성이 높아진다.

Purpose : In this study, we retrospectively analyzed the clinical outcomes of patients who underwent allogeneic hematopoietic stem cell transplantation (HSCT) grafted from HLA-matched parents. Methods : Seven children with acute leukemia (4 acute lymphoblastic leukemia, 3 acute myeloid leukemia) in first complete remission received allogeneic HSCT from their respective parents at the St. Marys Hospital between April, 1999 and October, 2005. The median age of patients at transplantation was 5 years (range, 1-11 years; 2 male, 5 female) and the median age of donors was 35 years (range, 30-41 years; 5 male, 2 female). We investigated the clinical outcomes such as engraftment, acute and chronic graft-versus-host disease (GVHD), transplant-related morbidity and mortality, relapse and survival. Results : Median time from transplantation to last follow-up was 69.5 months (range, 18.8-96.5 months). All patients were successfully engrafted, with a median time of 11 days (range, 10-16 days) and 26 days (range, 13-39 days) for neutrophil and platelet recovery, respectively. Grade II acute GVHD occurred in 3, and grade III acute GVHD in 1 of 7 recipients. Extensive chronic GVHD developed in 2, and limited chronic GVHD in 1 of 7 recipients. Death from transplant-related complications occurred in 1, and relapse occurred in 1 of 7 recipients. Estimated 5-year overall survival was $83{\pm}15%$. Conclusion : The clinical outcomes of recipients who underwent HSCT from HLA-matched parents were comparable to those of patients who received HSCT grafted from HLA-matched sibling donors in childhood leukemia. HLA typing of parents, as well as siblings will increase the likelihood of finding an HLA-matched family donor for patients who need HSCT.

키워드

참고문헌

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