重型地中海贫血单倍体造血干细胞移植后细胞因子释放综合征临床特征分析

Clinical characteristics of cytokine release syndrome after haploidentical hematopoietic stem cell transplantation for thalassemia major

摘要:

目的 探讨重型地中海贫（thalassemia major, TM）患儿单倍体造血干细胞移植（haploidentical hematopoietic stem cell transplantation, haplo-HSCT）后细胞因子释放综合征（cytokine release syndrome, CRS）的发生特点及预后。方法 回顾分析2019年1月—2021年12月在深圳市儿童医院血液肿瘤科采用haplo-HSCT的280例TM患儿，根据CRS标准分为CRS<3级组（260例）和CRS≥3级组（20例），分析TM患儿haplo-HSCT后CRS发生特点及预后。结果 两组患儿在中性粒细胞植入时间、CRS临床表现、移植后4 d内糖皮质激素使用率之间的差异有统计学意义（P分别为0.012、0.040、<0.001）。CRS<3级组移植后3个月内急性移植物抗宿主病（acute graft versus host disease, aGVHD）发生率为9.6%，CRS≥3级组移植后3个月内未发生aGVHD，但两组移植后3个月内aGVHD发生率差异无统计学意义（P=0.146）。两组患儿haplo-HSCT后3个月内均未发生移植相关死亡。结论 CRS≥3级组患儿haplo-HSCT后中性粒细胞植入时间早、CRS临床表现重且多样，移植后4 d内糖皮质激素使用率高。CRS≥3级患儿移植后早期使用小剂量糖皮质激素可减轻CRS反应和减少aGVHD的发生，使患儿受益。haplo-HSCT后CRS对预后无显著影响。

Abstract:

Objective To investigate the clinical characteristics of cytokine release syndrome (CRS) in children with thalassemia major (TM) after haploidentical hematopoietic stem cell transplantation (haplo-HSCT) and their prognosis.Methods A retrospective analysis was performed for the clinical data of 280 children with TM who underwent haplo-HSCT in the Department of Hematology and Oncology, Shenzhen Children's Hospital, from January 2019 to December 2021. According to the CRS criteria, they were divided into two groups: CRS grade <3 (260 children) and CRS grade ≥3 (20 children). The children with TM were analyzed in terms of clinical characteristics of CRS after haplo-HSCT and their prognosis.Results There were significant differences between the two groups in neutrophil engraftment time, clinical manifestations of CRS, and the rate of use of glucocorticoids within 4 days after haplo-HSCT (P=0.012, 0.040, and <0.001 respectively). For the CRS grade <3 group, the incidence rate of acute graft-versus-host disease (aGVHD) was 9.6% within 3 months after transplantation, while no aGVHD was observed in the CRS grade ≥3 group within 3 months after transplantation, but there was no significant difference in the incidence of aGVHD between the two groups within 3 months after transplantation (P=0.146). No transplantation-related death was observed in either group within 3 months after haplo-HSCT.Conclusions The children with CRS grade≥3 have an early neutrophil engraftment time, severe and diverse clinical manifestations of CRS, and a high rate of use of glucocorticoids within 4 days after haplo-HSCT. For these children, early use of low-dose glucocorticoids after transplantation may alleviate CRS response and reduce the incidence of aGVHD, thereby bringing more benefits to the children. CRS after haplo-HSCT has no significant impact on the prognosis of the children.