Ⅳ期高危神经母细胞瘤患儿自体造血干细胞移植红细胞输注的影响因素分析

doi:10.3969/j.issn.1671-2587.2025.03.003

临床输血与检验 ›› 2025, Vol. 27 ›› Issue (3): 300-305.DOI: 10.3969/j.issn.1671-2587.2025.03.003

Ⅳ期高危神经母细胞瘤患儿自体造血干细胞移植红细胞输注的影响因素分析

付晓艳, 甄自达, 马曙轩

首都医科大学附属北京儿童医院输血科, 北京 100045

收稿日期:2024-11-26 发布日期:2025-06-23
通讯作者: 马曙轩,主要从事儿科临床输血及儿童凝血功能研究,（E-mail）masxfwyy@sina.com。
作者简介:付晓艳,主要从事临床输血相关工作,（E-mail）646961901@qq.com。

Analysis of RBC Transfusion for Children with Stage Ⅳ High-risk Neuroblastoma Undergoing Autologous Hematopoietic Stem Cell Transplantation

FU Xiaoyan, ZHEN Zida, MA Shuxuan

Department of Blood Transfusion, Beijing Children's Hospital Affiliated of capital Medical University, Beijing 100045

Received:2024-11-26 Published:2025-06-23

摘要/Abstract

摘要： 目的总结Ⅳ期高危神经母细胞瘤（neuroblastoma, NB）患儿接受自体造血干细胞移植（autologous hematopoietic stem cell transplantation, ASCT）后的红细胞输注需求,并确定红细胞输注需求增加和脱离输注时间延长的危险因素。方法本研究为单中心回顾性临床研究,纳入我院2019年1月—2024年5月进行ASCT的Ⅳ期高危神经母细胞瘤患儿96例,收集并分析相关临床数据,包括年龄、性别、体表面积、干细胞回输日（d₀）血红蛋白水平、预处理方案、回输CD34⁺细胞数量、移植期间红细胞输注需求、移植后红细胞脱离输注时间等。结果所有96例（100%）患儿在移植后均需输注红细胞。自d₀至脱离输注,患儿中位输注红细胞次数为2（1.25,3）次,患儿中位输注红细胞单位数为2（2,3）U。患儿在移植后假愈期（d₄~d₆）和极期（d₇~d₁₄）的红细胞输注需求较大,分别为46.89%和86.46%。患儿移植后脱离红细胞输注的中位天数为10（8,12）天。多变量分析显示,干细胞回输日（d₀）Hb≤90 g/L、移植前1周需要输注红细胞和回输CD34⁺细胞剂量<4.0×10⁶/kg与红细胞需求量和输注次数增加相关,差异有统计学意义（P<0.05）。干细胞回输日(d₀)Hb≤90 g/L和回输CD34⁺细胞剂量<4.0×10⁶/kg与红细胞脱离输注时间延迟有关,差异有统计学意义(P<0.05)。年龄、性别、血型和预处理方案对NB患儿移植后红细胞输注需求和脱离输注时间的影响差异无统计学意义（P>0.05）。结论本研究提供了Ⅳ期高危神经母细胞瘤患儿ASCT后定量输注红细胞的数据,并确定了干细胞回输日(d₀)Hb≤90 g/L和回输CD34⁺细胞剂量<4.0×10⁶/kg是预测输血增加和导致输血独立时间延迟的危险因素。

关键词: 神经母细胞瘤, 自体造血干细胞移植, 红细胞输注, 预处理方案

Abstract: Objective To evaluate the RBC transfusion demand of children with stage Ⅳ high-risk neuroblastoma undergoing autologous hematopoietic stem cell transplantation (ASCT), as well as to identify increased or prolonged RBC transfusion requirement predictors. Methods This study was a single-center retrospective clinical study, and enrolled 96 children with stage Ⅳ high-risk neuroblastoma who underwent ASCT from January 2019 to May 2024 in our hospital. Relevant clinical data were collected and analyzed, including age, gender, body surface area, hemoglobin level of graft infusion day(d₀), prophylactic transfusion conditioning regimen, CD34⁺ stem cell dose, RBC transfusion requirements during transplantation, and time to transfusion independence, etc. Results All 96 (100%) children were transfused after ASCT. From d₀ to transfusion independence, median frequency for achieving RBC was 2 (1.25, 3), median of 2 (2,3) units of RBCs was given. RBC transfusions were relatively higher in pseudohealing stage (d₄~d₆) and polar stage (d₇~d₁₄), were 46.89% and 86.46%, respectively. Median times for achieving RBC transfusion independence was 10(8, 12) days. Multivariate analysis showed that Hb≤90 g/L on d₀, RBC transfusion within 1 week before ASCT and CD34⁺ stem cell dose<4.0×10⁶/kg were associated with significantly increased RBC requirements (P<0.05). Hb≤90 g/L on d₀ and CD34⁺ stem cell dose<4.0×10⁶/kg were associated with significantly entailed longer time until RBC independence (P<0.05). Effects of age, sex, blood group and pretreatment regimen were limited or insignificant (P>0.05). Conclusion This study for the first time provided quantitative RBC transfusion data after ASCT in pediatric stage Ⅳ high-risk neuroblastoma and identified Hb≤90 g/L on d₀ and CD34⁺ stem cell dose<4.0×10⁶/kg were factors predictive of increased transfusions and prolonged transfusion independence.

Key words: Neuroblastoma, Autologous hematopoietic stem cell transplantation, Red blood cell transfusion, Prophylactic transfusion conditioning regimen

中图分类号:

R739.43R457.1

付晓艳, 甄自达, 马曙轩. Ⅳ期高危神经母细胞瘤患儿自体造血干细胞移植红细胞输注的影响因素分析[J]. 临床输血与检验, 2025, 27(3): 300-305.

FU Xiaoyan, ZHEN Zida, MA Shuxuan. Analysis of RBC Transfusion for Children with Stage Ⅳ High-risk Neuroblastoma Undergoing Autologous Hematopoietic Stem Cell Transplantation[J]. JOURNAL OF CLINICAL TRANSFUSION AND LABORATORY MEDICINE, 2025, 27(3): 300-305.

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Ⅳ期高危神经母细胞瘤患儿自体造血干细胞移植红细胞输注的影响因素分析

Analysis of RBC Transfusion for Children with Stage Ⅳ High-risk Neuroblastoma Undergoing Autologous Hematopoietic Stem Cell Transplantation

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