Allogreffe decellules souches hématopoïétiques dans les leucémies aigues myéloblastiques de l’enfant: Survieet rechute
DOI :
https://doi.org/10.62438/tunismed.v103i11.5353Mots-clés :
Acute myeloblastic leukemia, children, allogeneic stem cell transplantation, survival, relapseRésumé
Introduction: L’allogreffe de cellules souches hématopoïétiques (allo-CSH) est indiquée dans Les leucémies aigues myéloblastiques (LAM) de l’enfant à haut risque (HR).
Objectif: Evaluer la survie globale(SG) , survie sans événement(SSE),la rechute et la mortalité non liée à la rechute (NRM).
Méthodes: Etude descriptive rétrospective, ayant inclus les enfants (˂18ans) atteints de LAM allogreffés à partir d’un donneur géno-identique entre1999 et2023. Le conditionnement pré-greffe était de type Busulfan-cyclophosphamide(BuCy)ou irradiation corporelle totale-Cy. Le greffon était de type moelle osseuse(MO)ou cellules souches périphériques.
Résultats: Cinquante-deux enfants ont été inclus avec un âge médian de 13ans (3-17ans).Les patients étaient Classés HR dans 60,3% des cas. Le délai médian diagnostic-greffe était de 5 mois (3-40mois). En pré-greffe,75% des patients étaient en RC1. Le greffon était de type MO dans 84,6% des cas. Le conditionnement était de type BuCy dans 90,4% des cas. Le taux de rejet était de 5,8%. Les incidences cumulées (IC) de la GVHD aigue et de la GVHD chronique étaient de 20% et de 23,4%, respectivement. L’IC de la NRM était de7,7% et de la rechute était de 44,7%. Après un suivi médian de 30mois (39j-18ans),l aSG et la SSE à 3 ans étaient de 51,6%et47,8%, respectivement.
Conclusion: La rechute postallo-CSH demeure un problème majeur.Le renforcement du Conditionnement pré-greffe, l’étude de la pharmacocinétique du Bu et le développement des
Thérapies ciblées pourraient réduirece risque
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PuiCH,CarrollWL,MeshinchiS,ArceciRJ.Biology,Risk Stratification ,and Therapy of Pediatric Acute
Leukemias: An Update.JClinOncol.2011;29(5):551‑65.
HarrisonCJ, HillsRK,MoormanAV,Grimwade DJ,HannI,Webb DK,et al.Cytogenetics of childhood acute
myeloid leukemia:United Kingdom MRC treatment trials AML 10 and 12.J Clin Oncol2010;28:2674-81.
Kharfan-DabajaMA,KumarA,AyalaE,AljurfM,NishihoriT,MarshR,etal.Standardizing Definitions of
Hematopoietic Recovery,Graft Rejection, Graft Failure,Poor Graft Function,and Donor Chimerismin
Allogeneic Hematopoietic Cell Transplantation: A Report on Behalf of the American Society for Transplantation
and Cellular Therapy.Transplant Cell Ther.2021;27(8):642‑9.
BenOthmanT,TorjemaneL,AbdelkefiA,LakhalA,LadebS,BenHamedL,etal.Allogeneic hematopoietic
stem cell transplantation in Tunisia.BMT.2008Aug:42Suppl1:S139-S141.
Ben AbdeljelilN,KanounRY,MekniS,TurkiI,BenYaicheI,OuerghiR,etal.Busulfan-cyclophosphamidevs
fludarabine-busulfan for allogeneic transplantin acute myeloid leukemia.Future Oncol.2025;21(15):1887-1894.
HaouasH,HaouasS,HafsiaA.A retrospectives tudy of leukemia epidemiology in Northern Tunisia.Hematology
;16(3):151-4.
GmidèneA,SennanaH,WahchiI,BenYoussefY,JeddiR,ElloumiM,etal.Cytogenetic profile of a large
cohort of Tunisian denovo acute myeloid leukemia.Hematology.2012;17(1):9-14.
BakhtiarS,Salzmann-ManriqueE,HutterM,KrennT,DuerkenM,FaberJ,etal.Allo HSCT in paediatric ALL
and AML in complete remission: improvement over time impacted by accreditation?Bone Marrow Transplant.
;54(5):737‑45.
DohertyEE,RedellM,SasaG,YassineK,JohnTD,CraddockJ,etal. Outcomes after Allogeneic Hematopoietic
Stem Cell Transplantation for Pediatric Acute Myeloid Leukemia in the Contemporary Era.Blood.
;134(Supplement_1):2056.
PochonC,DetraitM,DalleJH,MichelG,DhédinN,ChalandonY,etal.Improved out come in children compared
to adolescents and young adults after allogeneic hematopoietic stem cell transplant for acute myeloid leukemia:
a retrospective study from the Francophone Society of Bone Marrow Transplantation and Cell Therapy (SFGM-
TC).JCancerResClinOncol.2022;148(8):2083‑97.
AntierC,JullienM,TessoulinB,LoiratM,PeterlinP,GarnierA,etal.Late Relapse after Allogeneic Stem Cell
Transplantation in Patients Treated for Acute Myeloid Leukemia : Relapse Incidence,Characteristics, Role of
Conditioning Regimen, and Outcome. Cancers.2024;16(7):1419.
BejanyanN,WeisdorfDJ,LoganBR,WangHL,DevineSM,deLimaM,etal. Survival of AML patients
relapsing after allogeneic hematopoietic cell transplantation : a CIBMTR study.Biol Blood Marrow TransplantJ
Am Soc Blood Marrow Transplant.2015;21(3):454‑9.
CopelanEA,HamiltonBK,AvalosB,AhnKW,BolwellBJ,ZhuX,etal.Better leukemia-free and overall
survival in AML in first remission following cyclophosphamide in combination with busulfan compared with
TBI.Blood.2013;122(24):3863‑70.
IshidaH,KatoM,KudoK,TagaT,TomizawaD,MiyamuraT,etal.Comparison of Outcomes for Pediatric
Patients With Acute Myeloid Leukemia in Remission and Under going Allogeneic Hematopoietic Cell
Transplantation With Myeloablative Conditioning Regimens Basedon Either Intravenous Busulfanor Total Body
Irradiation:A Report From the Japanese Society for Hematopoietic Cell Transplantation .Biol Blood Marrow
Transplant JAm Soc Blood Marrow Transplant.2015;21(12):2141‑7.
LucasAGT,BhoopalanSV,NierkensS,deKoningC,KeerthiD,SeetharamanA,etal.Real World Use of the
Pediatric Disease Risk Index for Allogeneic Hematopoietic Cell Transplantation in Patients with Acute
Lymphoblastic Leukemia and Acute Myeloid Leukemia: A Multicenter Study.Transplant Cell Ther.2024;30(2,
Supplement):S107‑8.
AroraS,PushpamD,TiwariA,ChoudharyP,ChopraA,GuptaR,etal.Allogeneic hematopoietic stem cell
transplantin pediatric acute myeloid leukemia : Lessons learnt from atertiaryc are centerin India.Pediatr
Transplant.2021;25(3):e13918.
VersluysAB,BoelensJJ,PronkC,LankesterA,BordonV,BuechnerJ,etal.Hematopoietic cell transplantin
pediatric acute myeloid leukemia after similar up front therapy; acomparison of condition ingregimens.Bone
MarrowTransplant.2021;56(6):1426‑32.
RakhmanovaZ,PainaO,BarkhatovI,SadykovA,RazumovaS,TsvetkovaL,etal.Molecular genetic and
cytofluorimetric prognostic factors in the development of acute myeloid leukemia relapse in children after
allogeneic hematopoietic stem cell transplantation. Pediatr Hematol Immunopathol.2023;22:24‑30.
GrochowLB,JonesRJ,BrundrettRB,BraineHG,ChenTL,SaralR,etal.Pharma cokineticsofbusulfan:
correlation with veno-occlusive disease in patients undergoing bone marrow transplantation.Cancer Chemother
Pharmacol(1989)25:55-61.
KalwakK,MielcarekM,PatrickK,StyczynskiJ,BaderP,CorbaciogluS,etal.Treosulfan-fludarabine-thiotepa-
based conditioning treatment before allogeneic hematopoietic stem cell transplantation for pediatric patients with
hematological malignancies.Bone Marrow Transplant.2020;55(10):1996‑2007.
RehmanMEU,KhansuhebM,UmarH,FarheenNaazF,ShahZ,KhanZ,etal.Busulfanversustreosulfan
conditioning for acute myeloid leukemia and myelodysplastic syndrome:A systematic reviewand meta-analysis.
JClinOncol.2023;41(16_suppl):e19032‑e19032.
SantosGW,TutschkaPJ,BrookmeyerR,SaralR,BeschornerWE,BiasWB,etal.Marrow transplantation for
acute non lymphocytic leukemia after treatment with busulfanandcyclophosphamide.NEnglJMed.
;309(22):1347‑53.
MichelG,GluckmanE,Esperou-BourdeauH,ReiffersJ,PicoJL,BordigoniP,etal.Allogeneic bone marrow
transplantation for children with acute myeloblastic leukemia in first complete remission:impact of conditioning
regimen without total-body irradiation--areport from the Société Française de Greffe de Moelle.JClinOncol
OffJAmSocClin Oncol.1994;12(6):1217‑22.
BartelinkIH, ReijEMLvan,GerhardtCE,MaarseveenEM van,WildtAde, Versluys B,etal. Fludarabineand
Exposure-TargetedBusulfanCompares Favorably with Busulfan/Cyclophosphamide-BasedRegimensin
Pediatric Hematopoietic Cell Transplantation : Maintaining Efficacy with Less Toxicity.Biol Blood Marrow
Transplant.2014;20(3):345‑53.
BartelinkIH,BrediusRGM,BelitserSV,SuttorpMM,BieringsM,KnibbeCAJ,etal.Association between
Busulfan Exposure and Outcome in Children Receiving Intravenous Busulfanbefore Hematologic Stem Cell
Transplantation.Biol Blood Marrow Transplant.2009;15(2):231‑41.
BartelinkIH,LalmohamedA,vanReijEML,DvorakCC,SavicRM,ZwavelingJ,etal.ANew Harmonized
Approach to Estimate Busulfan Exposure Predicts Survivaland Toxicity after Hematopoietic Cell Transplantation
in Children and Young Adults :a Multicenter Retrospective Cohort Analysis .Lancet Haematol.
;3(11):e526‑36.
YanivI,KraussAC,BeohouE,DalissierA,CorbaciogluS,ZeccaM,etal.Second Hematopoietic Stem Cell
Transplantation forPost-Transplantation Relapsed Acute Leukemia in Children : A Retrospective EBMT-PDWP
Study.Biol Blood Marrow Transplant.2018;24(8):1629‑42.
UdenT,BertainaA,AbrahamssonJ,AnsariM,BalduzziA,BourquinJP,etal.Outcome of children relapsing
after first allogeneic haematopoietic stem cell transplantation for acute myeloid leukaemia: aretrospectiveI-BFM
analysis of 333 children.BrJHaematol.2020;189(4):745‑50.
SchmidC,LabopinM,NaglerA,BornhäuserM,FinkeJ,FassasA,etal.Donor lymphocyte in fusion in the
treatment offirst hematologicalr elapse after allogeneic stem-cell transplantation in adults with acute myeloid
leukemia: are trospective risk factors analysis and comparison with other strategies by the EBMT Acute Leukemia
Working Party.JClin Oncol Off JAm Soc Clin Oncol.2007;25(31):4938‑45.
KolbHJ,SchattenbergA,GoldmanJM,HertensteinB,JacobsenN,ArceseW,etal.Graft-Versus-Leukemia
Effect of Donor Lymphocyte Transfusions in Marrow Grafted Patients.Blood.1995;86(5):2041‑50.
CzogałaM,CzogałaW,Pawińska-WąsikowskaK,KsiążekT,Bukowska-StrakovaK,Sikorska-FicB,etal.
Characteristics and Outcome ofFLT3-ITD-Positive Pediatric Acute Myeloid Leukemia—Experience of Polish
Pediatric Leukemia and Lymphoma Study Group from 2005 to 2022. Cancers.2023;15(18):4557.
BuldiniB,Maurer-GranofszkyM,VarottoEandDworzakMN.Flow-Cytometric Monitoring of Minimal
Residual Disease in Pediatric Patients With Acute Myeloid Leukemia :Recent Advances and Future Strategies.
Front.Pediatr.2019;7:412.
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