《医院管理学习：儿童急性髓系白血病的造血干细胞移植治疗中国医学科学院血液病医院实践（PPT课件）》由会员分享，可在线阅读，更多相关《医院管理学习：儿童急性髓系白血病的造血干细胞移植治疗中国医学科学院血液病医院实践（PPT课件）（34页珍藏版）》请在金锄头文库上搜索。
1、儿童急性髓系白血病的造血干细胞移植治疗,实践案例：中国医学科学院 血液病医院,【医院管理案例学习】,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案及强度调整 供体选择 新药为更多儿童赢得移植机会 移植后复发的预防和管理 我们的实践,Proportions of disease indications for an HSCT in Europe in 2012,Proportions of disease indications for an allo-HSCT in Europe in 2012. Proportions of disease indications
2、 for an auto-HSCT in Europe in 2012. Passweg JR, et al. BMT. 2014, 49: 744750.,3,Two-tier risk stratification schema,Carpenter PA1, et al. BBMT. 2012, 18: S33-S39.,4,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案及强度调整 供体选择 儿童移植前MRD状态与移植预后 移植后复发的预防和管理 我们的实践,Transplantation Outcomes,Ishida H, et al. BBMT. 2015
3、, 21: 2141-2147.,6,急慢性GVHD发生情况,Ishida H, et al. BBMT. 2015, 21: 2141-2147.,7,Cause of Death,Ishida H, et al. BBMT. 2015, 21: 2141-2147.,8,Relapse, NRM and RFS probability according to conditioning regimens,Ishida H, et al. BBMT. 2015, 21: 2141-2147.,9,TBI-MAC was no better than i.v. BU-MAC for pedia
4、tric AML patients in remission,10,Patient Characteristics,11,Sisler IY, et al. BBMT. 2009, 15:1620-1627.,Univariate Analysis of Transplantation Outcomes according to conditioning regimens,Sisler IY, et al. BBMT. 2009, 15:1620-1627.,12,TRM, Relapse, EFS and OS probability according to conditioning re
5、gimens,TRMRelapse,13,EFS,OS,Sisler IY, et al. BBMT. 2009, 15:1620-1627.,Causes of Death,Sisler IY, et al. BBMT. 2009, 15:1620-1627.,14,Multivariate Analysis of Transplantation Outcomes according to conditioning regimens,15,Sisler IY, et al. BBMT. 2009, 15:1620-1627.,Brief summary,16,efficacy,The dat
6、a presented here indicate no difference between the TBI group and Bu group When choosing a conditioning regimen, clinicians must consider the early and long- term toxicity of their use, in addition to their Sisler IY, et al. BBMT. 2009,15:1620-1627.,BBMT. 2016, 22: 698-704.,17,Research purpose：The f
7、easibility and toxicity of RIC alloHSCT followed by GO targeted immunotherapy in children with CD33+ AML in CR1/CR2 RIC Regimen: flu 30 mg/m2 6 days, Bu 3.2 to 4 mg/kg 2 daysrabbit ATG 2 mg/kg 4 days followed by alloHSCT from matched related/unrelated donors GO Administration: 60 days after alloHSCT
8、 in 2 doses (8 weeks apart), following a dose-escalation design (4.5, 6, 7.5, and 9 mg/m2),Patient Demographics, Donor Sources, and Outcomes,Zahler S, et al. BBMT. 2016, 22: 698-704.,18,Hematopoietic Reconstitution, and Donor,Chimerism,19,Zahler S, et al. BBMT. 2016, 22: 698-704.,GVHD and Survival,c
9、,D,Probability of aGVHD was 21.4 by day +100,Probability of cGVHD was 33.5 by day 365,Zahler S, et al. BBMT. 2016, 22: 698-704. 20,Probability of OS and EFS in all patients,Probability of OS and EFS in CR1 patients,Brief summary,Zahler S, et al. BBMT. 2016, 22: 698-704. 21,OS at 1 and 5 years was 78
10、% and 61%, respectively. EFS of 5 year in patients in CR1 was 78%. No dose-limiting toxicities probably or directly related to GO were observed in this cohort. This preliminary data demonstrate that RIC followed by alloHSCT and consolidation with GO appears to be safe in children and adolescents wit
11、h CD33+ AML in CR1/CR2.,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案及强度调整 供体选择 新药为更多儿童赢得移植机会 移植后复发的预防和管理 我们的实践,Numbers of HSCTs in Europe in 2012,Passweg JR, et al. BMT. 2014, 49: 744750.,无关脐带血与HLA相合同胞比较,24,TRM, Relapse, OS and LFS,Zheng CC, et al. Ann Hematol. 2015, 94: 473480.,25,USC、UCB及MSD来源供者OS及LFS比较,
12、OS,26,LFS,USD 77.8% MSD 67.2% UCB 63.3%,USD 73.1% UCB 59.8% MSD 59.6%,Tang XF, et al. Pediatr Transplantation. 2015, 19: 413421.,OS, LFS, TRM and relapse after transplantation from HID or MSD in paediatric AL,Liu DH, et al. BMT. 2013, 48: 1519-1524.,27,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案选择及强度调整 供体
13、选择 新药为更多儿童赢得移植机会 移植后复发的预防和管理 我们的实践,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案及强度调整 供体选择 新药为更多儿童赢得移植机会 移植后复发的预防和管理 我们的实践,移植后复发的预防和管理,30,MRD+可否移植？ MRD+监测 移植后复发的药物预防？ 免疫抑制剂的减停 供者淋巴细胞输注 二次移植？,Cumulative incidence of relapse and EFS by WT1 status prior to HSCT,p 0.0001,31,p 0.0001,Woehlecke C, et al. J Cancer Res Clin Oncol. 2015, 141: 523529.,OS stratified by level of MRD,Leung W, et al. Blood. 2012, 120(2): 468-472.,32,MRD assessment,Bacher U, et al. BBMT. 2012, 18: S62-S73.,33,内容提要,移植治疗儿童急性髓系白血病适应证 改善移植疗效的尝试 预处理方案及强度调整 供体选择 新药为更多儿童赢得移植机会 移植后复发的预防和管理 我们的实践,
