Clinical efficacy of autologous hematopoietic stem cell transplantation based on TBM preparative regimen in the treatment of children with high-risk neuroblastoma
Objective To analyze the clinical efficacy of autologous hematopoietic stem cell transplantation(ASCT)based on TBM(thiotepa+busulfan+melphalan)preparative regimen in the treatment of children with high-risk neuroblastoma.Methods Seven children with high-risk neuroblastoma who received ASCT based on TBM preparative regimen at the Transplantation Center of the Department of Hematology,People's Hospital of Xinjiang Uygur Autonomous Region from November 5,2021 to September 8,2022 were enrolled.The hematopoietic reconstruction and transplantation-related adverse events were evaluated.The clinical efficacy,efficacy related indexes,follow-up results,nutritional indicators in children were analyzed.Results The 7 high-risk neuroblastoma children had a median age of 6.2(2-13)years.Autologous stem cells were collected from all children and frozen for transplantation.The median mononuclear cell count(MNC)and CD34+cells were 12.17(8.65-28.81)×108/kg and 4.15(2.11-13.12)×106/kg respectively.Hematopoietic reconstruction was achieved in all patients,with a median implantation time of neutrophils and platelets of 11(9-18)days,and 16(13-31)days,respectively.All children survived during the follow-up period,with 4(51.7％)developed grade Ⅲmucositis or above.Five(71.4％)cases had grade Ⅲ-Ⅳ vomiting diarrhea and other gastrointestinal adverse reactions.There were 2(28.5％)cases of drug-induced liver injury.No preconditioning-related toxic reactions in the nervous system and kidney,and hepatic sinusoidal obstruction syndrome were observed.Nutritional indicators,such as prealbumin(PAB),albumin(ALB)and hemoglobin(HB)before and after treatment were comparable without significant differences(P＞0.05).Conclusion TBM protocol is effective in the preconditioning of autologous hematopoietic stem cell transplantation in children with high-risk neuroblastoma,and the adverse reactions are common and controllable.
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