¼Ò¾Æ ¹éÇ÷º´ ȯÀÚÀÇ µ¿Á¾ Á¶Ç÷¸ð¼¼Æ÷ÀÌ½Ä Àüóġ·Î¼ Àü½Å¹æ»ç¼± Á¶»ç Æ÷ÇÔ±º°ú ºñÆ÷ÇÔ±ºÀÇ ºñ±³
Comparison of total body irradiation-based or non-total body irradiation-based conditioning regimens for allogeneic stem cell transplantation in pediatric leukemia patients
Korean Journal of Pediatrics 2010³â 53±Ç 4È£ p.538 ~ p.547
±è»óÁ¤(Kim Sang-Jeong) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
Çѵ¿±Õ(Han Dong-Kyun) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
¹éÈñÁ¶(Baek Hee-Jo) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
±èµ¿¿¬(Kim Dong-Yeon) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
³²ÅñÙ(Nam Taek-Keun) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¹æ»ç¼±Á¾¾çÇб³½Ç
ȲÅÂÁÖ(Hwang Tai-Ju) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
±¹ÈÆ(Kook Hoon) - Àü³²´ëÇб³ ÀÇ°ú´ëÇÐ ¼Ò¾Æ°úÇб³½Ç
Abstract
¸ñ Àû: º» ¿¬±¸ÀÇ ¸ñÀûÀº ¼Ò¾Æ¹éÇ÷º´ ȯÀÚ¿¡¼ ÀÌ½Ä Àüóġ·Î¼ Àü½Å¹æ»ç¼±Á¶»ç(total body irradiation, TBI)±º°ú ºñ¹æ»ç¼±Á¶»ç(non-TBI)±º°úÀÇ ÀÌ½Ä ¼ºÀû ¹× ¿¹Èĸ¦ ºñ±³ÇÏ°íÀÚ ÇÏ¿´´Ù.
¹æ ¹ý: 1996³â 1¿ù¿¡¼ 2007³â 12¿ù±îÁö Àü³²´ëÇб³º´¿ø¿¡¼ Á¶Ç÷¸ð¼¼Æ÷À̽ÄÀ» ½ÃÇà ¹ÞÀº ¼Ò¾Æ¹éÇ÷º´ ȯÀÚ 77¸íÀ» TBI±º
(n=40)°ú non-TBI±º(n=37)À¸·Î ³ª´©¾î °¢ ±º °£ÀÇ ÀÌ½Ä À¯Çü, ÀÌ½Ä ½Ã Áúº´»óÅÂ, Àüóġ ¹æ¹ý, ÀÌ½Ä ¼¼Æ÷ ¼ö, »ýÂø ¼Óµµ, À̽ÄÆí´ë¼÷ÁÖ¹ÝÀÀ(graft-versus-host disease, GVHD)ÀÇ ¹ß»ýºóµµ, ÀÌ½Ä ÇÕº´Áõ, »ç¸Á¿øÀÎ, Àüü»ýÁ¸À²(overall survival, OS)°ú ¹«»ç°Ç»ýÁ¸À²(event free survival, EFS) ¹× Èıâ ÇÕº´ÁõÀ» ºñ±³ ºÐ¼®ÇÏ¿´´Ù.
°á °ú: ±Þ¼º¸²ÇÁ±¸¼º¹éÇ÷º´(acute lymphoblastic leukemia, ALL) ȯÀÚÀÇ 82.4% (28/34)´Â TBI¸¦ ¹Þ¾Ò°í, °ñ¼ö°è¿ ¹éÇ÷º´ ȯÀÚÀÇ 72.7% (24/33)´Â non-TBI ±ºÀ̾ú´Ù. Àüü ȯÀÚ¸¦ ´ë»óÀ¸·Î TBI ¿©ºÎ¿¡ µû¸¥ 5³â EFSÀº µÎ ±º°£ Â÷ÀÌ´Â ¾ø¾úÀ¸³ª (62% vs. 63%), ALL ȯÀÚ¿¡¼´Â TBI±ºÀÌ non-TBI±º¿¡ ºñÇØ Åë°èÀûÀ¸·Î À¯ÀÇÇÏ°Ô ¿ì¼öÇÑ 5³â EFSÀ» º¸¿´´Ù(65% vs. 17%; P =0.005). AML (acute myelogenous leukemia) ȯÀÚ¿¡¼´Â non-TBI±ºÀÌ TBI±ºº¸´Ù ´õ ³ôÀº 5³â EFSÀ» º¸¿´À¸³ª Åë°èÀûÀÎ À¯ÀǼºÀº ¾ø¾ú´Ù(73% vs. 38 %; P =0.089). GVHD ¹ß»ý·ü,»ýÂø, »ç¸Á¿øÀΰú Èıâ ÇÕº´ÁõÀº µÎ ±º°£ Â÷ÀÌ´Â ¾ø¾ú´Ù.
°á ·Ð: Àüóġ·Î¼ TBI±º°ú non-TBI±ºÀº ºñ½ÁÇÑ °á°ú¸¦ º¸¿´À¸³ª, ALLȯÀÚ¿¡¼´Â TBI±ºÀÌ non-TBI±º¿¡ ºñÇÏ¿© À¯ÀÇÇÏ
°Ô ¿ì¼öÇÑ 5³â EFSÀ» º¸¿´´Ù. µÎ ±º°£ Èıâ ÇÕº´ÁõÀÇ ¹ß»ý ¹× »çȸ°æÁ¦Àû »îÀÇ ÁúÀ» ºñ±³Çϱâ À§ÇÏ¿©´Â ¸¹Àº ȯÀÚ¸¦ ´ë»óÀ¸·ÎÇÑ
ÀüÇâÀû ¹«ÀÛÀ§ ¿¬±¸°¡ ÇÊ¿äÇϸ®¶ó »ç·áµÈ´Ù.
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.
Å°¿öµå
Transplantation conditioning, Leukemia, Hematopoietic stem cell, Child
KMID :
1130320100530040538
¿ø¹® ¹× ¸µÅ©¾Æ¿ô Á¤º¸
µîÀçÀú³Î Á¤º¸
À¯È¿¼º°á°ú(Recomendation)
ȯÀÚ¿¡¼´Â TBI±ºÀÌ non-TBI±º¿¡ ºñÇØ Åë°èÀûÀ¸·Î À¯ÀÇÇÏ°Ô ¿ì¼öÇÑ 5³â EFSÀ» º¸¿´´Ù(65% vs. 17%; P =0.005)