摘要
目的观察131I标记间碘苄胍(131I-MIBG)在儿童高危神经母细胞瘤(HR-NB)巩固治疗中的近期疗效及毒副作用。方法选择2014年1月—2018年2月在北京儿童医院血液肿瘤中心确诊为HR-NB,且巩固治疗前MIBG显像阳性予以131I-MIBG治疗的34例患儿,回顾性分析其初诊时、131I–MIBG治疗前后肿瘤标记物、骨髓细胞学检查、骨髓微小残留病灶及原发瘤灶大小等的变化,观察131I-MIBG治疗后骨髓毒性、肝肾功能及甲状腺功能等毒副作用。结果34例患儿经过化疗、手术、自体造血干细胞移植或局部放射治疗后,在131I-MIBG巩固治疗前评估为可疑肿瘤进展者15例。接受131I-MIBG治疗的中位次数为2(1~6)次,单次治疗剂量为90~200mCi(3330~7400MBq)。131I-MIBG治疗后有4/6例患儿LDH降至正常,4/7例NSE有下降,5/10例尿VMA恢复正常,9/10例骨髓MRD转为阴性。治疗后仍有肿瘤进展者12例。中位随访21个月,预计经131I-MIBG治疗患儿3年总生存率(OS)为69.9%,明显高于同期212例未经131I-MIBG治疗的患儿(P<0.05),预计3年无事件生存率(EFS)为50.4%,相比差异无显著性(P>0.05)。所有患儿均出现骨髓抑制,中位持续时间4(1~16)个月,以3度血小板减少症为著,无肝肾及甲状腺功能损害。结论131I-MIBG是儿童HR-NB有效的巩固治疗手段,其毒副反应以骨髓抑制为主,尤以重度血小板减低为著,无明显肝肾功能损害。
Objective To observe the toxic side and recent effect curative of 131I-metaiodobenzylguanidine(131I-MIBG)in children with high risk neuroblastoma(HR-NB),and to evaluate its effectiveness and safety.Methods This was a retrospective cohort analysis of 34 patients with HR-NB diagnosed from January 2014 to February 2018 at Hematology Oncology Center,Beijing Children′s Hospital.And they had positive MIBG imaging before 131I-MIBG therapy.The viration of tumor markers,primary tumor size,bone marrow cells and minimal residual disease(MRD)were analyzed at the time of initial diagnosis,before and after 131I-MIBG treatment.The toxicity of bone marrow,liver,kidney and thyroid function after 131I-MIBG treatment were observed to evaluate the safety.Results Thirty-four patients treated with chemotherapy,operation,autologous hematopoietic stem cell transplantation and local radiotherapy.And 15 patients were evaluated as suspected progression before 131I-MIBG consolidation treatment.The median number of treatments was 2(1-6),with a single dose of 90~200mCi(3330~7400MBq).4/6 cases of patient with slightly higher LDH before 131I-MIBG treatment returned to normal after treatment.4/7 patients with elevated NSE decreased and 5/10 patients with abnormal urinary VMA returned to normal after treatment.9/10 cases of bone marrow MRD positive patients turned negative after treatment.There were still 12 cases of PD after MIBG.Median follow-up time was 21 months.The 3-year overall survival rate was estimated to be 69.9%,which is significantly higher than that of patients without 131I-MIBG treatment in the same period(P<0.05).The 3-year event-free survival rate was 50.4%.And there was no significant difference compared with the regular treatment group(P>0.05).All 34 patients had myelosuppression.The total duration was 1~16 months and the median duration was 4 months.Most common was thrombocytopenia of 3 degrees,and no impairment of heart,liver,kidney and thyroid function.Conclusions Preliminary clinical findings show that 131I-MIBG is an eff
作者
蒋持怡
苏雁
于彤
秦茂权
金眉
张大伟
杨吉刚
丁勇
马晓莉
JIANG Chiyi;SU Yan;YU Tong;QIN Maoquan;JIN Mei;ZHANG Dawei;YANG Jigang;DING Yong;MA Xiaoli(National Children′s Medical Center,Beijing Key Laboratory of Pediatric Hematology Oncology,National Key Discipline of Pediatrics,Ministry of Education,MOE Key Laboratory of Major Diseases in Children,Hematology Oncology Center,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;National Children′s Medical Center,Image Center,Beijing Children′s Hospital,Capital Medical University,Beijing 100045,China;Nuclear Medicine Department,Beijing Friendship Hospital,Capital Medical University,Beijing 100050,China;Nuclear Medicine Department,Fifth Medical Center of Chinese PLA General Hospital,Hospital Affiliated to the Academy of Military Medical Sciences,Beijing 100071,China)
出处
《中国小儿血液与肿瘤杂志》
CAS
2019年第5期253-257,共5页
Journal of China Pediatric Blood and Cancer
