儿童急性白血病的干细胞移植后维持治疗：来自巴西某机构的经验与拉丁美洲视角

This retrospective study included pediatric acute leukemia patients who underwent HSCT between 2014 and 2024. Post-HSCT maintenance therapy became standard practice in 2021, utilizing agents like venetoclax, decitabine, azacitidine, blinatumomab, DLI, and targeted therapies. Primary outcomes were overall survival (OS) and disease-free survival (DFS); secondary outcomes included relapse rate and treatment-related toxicities.

Among 94 patients (64 with ALL, 30 with AML), ALL patients receiving maintenance therapy had an OS of 78% versus 47% without maintenance (p=0.02); DFS was 64% with maintenance and 45% without (p=0.12). In AML patients, maintenance was associated with an OS of 88% compared to 27% without. Relapse rates decreased in maintenance-treated patients, especially among AML patients with pre-transplant MRD positivity. Treatments were generally well-tolerated, with manageable toxicities. DISCUSSION: Post-HSCT maintenance therapy is feasible in resource-limited settings and may improve survival outcomes. Strategies like hypomethylating agents with venetoclax in T-ALL and post-HSCT blinatumomab in B-ALL show potential benefits. Challenges include drug access and standardizing protocols. Further trials are needed to validate these findings in low- and middle-income countries.