摘要
目的评价贝林妥欧单抗治疗儿童急性B淋巴细胞白血病(B-ALL)的安全性及有效性。方法回顾性分析2022年5月至2024年4月西安交通大学第一附属医院儿科使用贝林妥欧单抗治疗的10例B-ALL患儿的临床资料。结果10例B-ALL患儿骨髓形态学均完全缓解且微小残留病(MRD)均阴性,化疗后均出现严重不良事件,包括颅内静脉窦血栓伴急性脑梗死、急性胰腺炎、麻痹性肠梗阻、抗利尿激素异常分泌综合征、肝损伤、脓毒症(耐β-内酰胺大肠埃希菌、铜绿假单胞菌)、口腔黏膜炎、持续粒细胞缺乏伴血流感染、重症肺炎、严重过敏反应。患儿均中断或延迟化疗,插入贝林妥欧单抗治疗14 d,治疗期间不良反应在血液学毒性方面,有5例在治疗第1~7天内出现3~4级中性粒细胞减少;非血液学毒性方面,4例治疗第1~3天出现一过性低热,1例治疗第7天头痛,第14天头痛加重并给予甘露醇治疗后好转,3例轻度肝损伤,1例治疗第2天IL-6升高达峰值71.86 pg/mL,其余患儿IL-6均正常,均未发生细胞因子释放综合征。贝林妥欧单抗治疗14 d后,5例患儿总T淋巴细胞计数出现扩增,10例B淋巴细胞计数、血清免疫球蛋白均降低,其中3例为低丙种球蛋白血症。随访中位时间7.8(3.0~24.0)个月,10例患儿无复发,持续MRD阴性完全缓解,6个月无进展生存率及总生存率均为100%。结论贝林妥欧单抗治疗儿童B-ALL安全性优于传统化疗,可作为不能耐受传统化疗的儿童ALL治疗新策略。
Objective To assess the safety and efficacy of Blinatumomab in treating children with acute B-lymphoblastic leukemia(B-ALL).Methods The clinical data of 10 B-ALL children who were admitted to the Department of Pediatrics,the First Affiliated Hospital of Xi’an Jiaotong University from May 2022 to April 2024 and treated with Blinatumomab were analyzed retrospectively.Results All the 10 cases had a complete remission of bone marrow and all minimal residual disease(MRD)were negative.Serious adverse events were reported after chemotherapy,including intracranial venous sinus thrombosis with acute cerebral infarction,acute pancreatitis,paralytic ileus,syndrome of abnormal secretion of antidiuretic hormone,severe pneumonia,liver injury,sepsis(β-lactamase resistant Escherichia coli,Pseudomonas aeruginosa),oral mucositis,persistent agranulocytosis with bloodstream infection.All patients interrupted chemotherapy and received Blinatumomab injections for 14 days.During treatment,there was hematological toxicity,which resulted in grade 3-4 neutropenia in 5 cases within the first 7 days.Transient low-grade fever was observed in 4 cases of non-hematological toxicity during days 1-3 of treatment.One patient experienced a headache on the 7th day of treatment,which worsened on the 14th day,but it improved with mannitol treatment.Mild liver injury was present in 3 cases.Interleukin-6 reached a peak of 71.86 pg/mL on the second day of treatment in one case,whereas it was normal in others.All patients were found to be free of cytokine release syndrome.T lymphocyte count increased in 5 patients after 14 days of Blinatumomab treatment,but B lymphocyte count and serum immunoglobulin levels declined in 10 patients.Hypogammaglobulinemia was observed in 3 of these patients.The median follow-up time was 7.8(3.0-24.0)months.All patients achieved MRD-negative complete remission and 6-month overall survival rate and progression-free survival were both 100%.Conclusion Children with B-ALL can benefit from using Blinatumomab,which is safer than conventional chemotherapy,as a new treatment strategy for those who cannot tolerate traditional chemotherapy.
作者
何敏
贺鑫禹
刘海玲
丁玎
徐曼
廉国利
刘志刚
He Min;He Xinyu;Liu Hailing;Ding Ding;Xu Man;Lian Guoli;Liu Zhigang(Department of Pediatrics,First Affiliated Hospital of Xi'an Jiaotong University,Xi'an 710061,China)
出处
《中国小儿急救医学》
2025年第10期743-747,共5页
Chinese Pediatric Emergency Medicine
