Clinical and Experimental Pediatrics

대한소아청소년과학회 (The Korean Pediatric Society)
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소아 백혈병 환자의 동종 조혈모세포이식 전처치로서 전신방사선 조사 포함군과 비포함군의 비교

Comparison of total body irradiation-based or non-total body irradiation-based conditioning regimens for allogeneic stem cell transplantation in pediatric leukemia patients

  • 김상정 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과) ;
  • 한동균 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과) ;
  • 백희조 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과) ;
  • 김동연 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과) ;
  • 남택근 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 방사선종양학과) ;
  • 황태주 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과) ;
  • 국훈 (전남대학교 의과대학 소아과학교실, 화순전남대학교병원 소아청소년과)
  • Kim, Sang-Jeong (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Han, Dong-Kyun (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Baek, Hee-Jo (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Kim, Dong-Yeon (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Nam, Taek-Keun (Department of Radiation Oncology, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Hwang, Tai-Ju (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School) ;
  • Kook, Hoon (Department of Pediatrics, Chonnam National University Hwasun Hospital Chonnam National University Medical School)
  • 투고 : 2010.01.12
  • 심사 : 2010.03.02
  • 발행 : 2010.04.15
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초록

목 적 : 본 연구의 목적은 소아백혈병 환자에서 이식 전처치로서 전신방사선조사(total body irradiation, TBI)군과 비방사선조사(non-TBI)군과의 이식 성적 및 예후를 비교하고자 하였다. 방 법: 1996년 1월에서 2007년 12월까지 전남대학교병원에서 조혈모세포이식을 시행 받은 소아백혈병 환자 77명을 TBI군(n=40)과 non-TBI군(n=37)으로 나누어 각 군 간의 이식 유형, 이식 시 질병상태, 전처치 방법, 이식 세포 수, 생착 속도, 이식편대숙주반응(graft-versus-host disease, GVHD)의 발생빈도, 이식 합병증, 사망원인, 전체생존율(overall survival, OS)과 무사건생존율(event free survival, EFS) 및 후기 합병증을 비교 분석하였다. 결 과 : 급성림프구성백혈병(acute lymphoblastic leukemia, ALL) 환자의 82.4% (28/34)는 TBI를 받았고, 골수계열 백혈병 환자의 72.7% (24/33)는 non-TBI 군이었다. 전체 환자를 대상으로 TBI 여부에 따른 5년 EFS은 두 군간 차이는 없었으나 (62% vs. 63%), ALL 환자에서는 TBI군이 non-TBI군에 비해 통계적으로 유의하게 우수한 5년 EFS을 보였다(65% vs. 17%; $P$=0.005). AML (acute myelogenous leukemia) 환자에서는 non-TBI군이 TBI군보다 더 높은 5년 EFS을 보였으나 통계적인 유의성은 없었다(73% vs. 38 %; $P$=0.089). GVHD 발생률, 생착, 사망원인과 후기 합병증은 두 군간 차이는 없었다. 결 론 : 전처치로서 TBI군과 non-TBI군은 비슷한 결과를 보였으나, ALL환자에서는 TBI군이 non-TBI군에 비하여 유의하게 우수한 5년 EFS을 보였다. 두 군간 후기 합병증의 발생 및 사회경제적 삶의 질을 비교하기 위하여는 많은 환자를 대상으로한 전향적 무작위 연구가 필요하리라 사료된다.

Purpose : This study aims to compare the outcome of total body irradiation (TBI)- or non-TBI-containing conditioning regimens for leukemia in children. Methods : We retrospectively evaluated 77 children conditioned with TBI (n=40) or non-TBI (n=37) regimens, transplanted at Chonnam National University Hospital between January 1996 and December 2007. The type of transplantation, disease status at the time of transplant, conditioning regimen, engraftment kinetics, development of graft-versus-host disease (GVHD), complications, cause of deaths, overall survival (OS), and event-free survival (EFS) were compared between the 2 groups. Results : Among 34 patients with acute lymphoblastic leukemia (ALL), 28 (82.4%) were in the TBI group, while 72.7% (24/33) of patients with myeloid leukemia were in the non-TBI group. Although the 5-year EFS of the 2 groups was similar for all patients (62% vs 63%), the TBI group showed a better 5-year EFS than the non-TBI group when only ALL patients were analyzed (65% vs 17%; $P$=0.005). In acute myelogenous leukemia patients, the non-TBI group had better survival tendency (73% vs 38%; $P$=0.089). The incidence of GVHD, engraftment, survival, cause of death, and late complications was not different between the 2 groups. Conclusion : The TBI and non-TBI groups showed comparable results, but the TBI group showed a significantly higher 5-year EFS than the non-TBI group in ALL patients. Further prospective, randomized controlled studies involving larger number of patients are needed to assess the late-onset complications and to compare the socioeconomic quality of life.

키워드

참고문헌

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  1. 소아백혈병의 전신방사선조사시 선량평가 vol.7, pp.4, 2013, https://doi.org/10.7742/jksr.2013.7.4.259
  2. 소아백혈병의 전신방사선조사 시 조직보상체의 두께변화에 따른 선량평가 vol.14, pp.4, 2014, https://doi.org/10.5392/jkca.2014.14.04.249
  3. 전신방사선치료시 산란체의 두께에 따른 선량측정 vol.8, pp.5, 2010, https://doi.org/10.7742/jksr.2014.8.5.265
  4. 전신방사선치료시 산란체의 두께에 따른 선량측정 vol.8, pp.5, 2010, https://doi.org/10.7742/jksr.2014.8.5.265
  5. Myeloablative Hematopoietic Stem Cell Transplantation with a Non-total Body Irradiation Regimen for Treating Pediatric Acute Lymphoblastic Leukemia vol.24, pp.1, 2017, https://doi.org/10.15264/cpho.2017.24.1.55
  6. Beam Spoiler-dependent Total Body Irradiation Dose Assessment vol.41, pp.2, 2010, https://doi.org/10.17946/jrst.2018.41.2.141