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<article xmlns:mml="http://www.w3.org/1998/Math/MathML" xmlns:xlink="http://www.w3.org/1999/xlink" xmlns:xsi="http://www.w3.org/2001/XMLSchema-instance" xmlns:ali="http://www.niso.org/schemas/ali/1.0/" article-type="other" dtd-version="1.2" xml:lang="en"><front><journal-meta><journal-id journal-id-type="publisher-id">Pediatric Hematology/Oncology and Immunopathology</journal-id><journal-title-group><journal-title xml:lang="en">Pediatric Hematology/Oncology and Immunopathology</journal-title><trans-title-group xml:lang="ru"><trans-title>Вопросы гематологии/онкологии и иммунопатологии в педиатрии</trans-title></trans-title-group></journal-title-group><issn publication-format="print">1726-1708</issn><issn publication-format="electronic">2414-9314</issn><publisher><publisher-name xml:lang="en">Fund Doctors, Innovations, Science for Children</publisher-name></publisher></journal-meta><article-meta><article-id pub-id-type="publisher-id">603</article-id><article-id pub-id-type="doi">10.24287/1726-1708-2022-21-2-22-31</article-id><article-categories><subj-group subj-group-type="toc-heading" xml:lang="en"><subject>ORIGINAL ARTICLES</subject></subj-group><subj-group subj-group-type="toc-heading" xml:lang="ru"><subject>ОРИГИНАЛЬНЫЕ СТАТЬИ</subject></subj-group><subj-group subj-group-type="article-type"><subject>Unknown</subject></subj-group></article-categories><title-group><article-title xml:lang="en">The results of ten years’ experience in allogeneic hematopoietic stem cell transplantation at the Russian Children’s Clinical Hospital</article-title><trans-title-group xml:lang="ru"><trans-title>Анализ результатов 10-летнего опыта проведения трансплантаций аллогенных гемопоэтических стволовых клеток в Российской детской клинической больнице</trans-title></trans-title-group></title-group><contrib-group><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-3797-5808</contrib-id><name-alternatives><name xml:lang="en"><surname>Sidorova</surname><given-names>N. V.</given-names></name><name xml:lang="ru"><surname>Сидорова</surname><given-names>Н. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Assistant Lecturer at the Department of Oncology, Hematology and Radiotherapy</p></bio><bio xml:lang="ru"><p>ассистент кафедры онкологии, гематологии и лучевой терапии</p>
<p> </p></bio><email>valerevna25@mail.ru</email><xref ref-type="aff" rid="aff1"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Rumyantsev</surname><given-names>S. A.</given-names></name><name xml:lang="ru"><surname>Румянцев</surname><given-names>С. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow</p></bio><bio xml:lang="ru"><p>заведующий кафедрой онкологии, гематологии и лучевой терапии ПФ</p></bio><email>s_roumiantsev@mail.ru</email><xref ref-type="aff" rid="aff2"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-2395-4045</contrib-id><name-alternatives><name xml:lang="en"><surname>Machneva</surname><given-names>E. B.</given-names></name><name xml:lang="ru"><surname>Мачнева</surname><given-names>Е. Б.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач-гематолог отделения трансплантации костного мозга</p>
<p>Москва</p></bio><email>lena.machneva@yandex.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-4569-657X</contrib-id><name-alternatives><name xml:lang="en"><surname>Pristanskova</surname><given-names>E. A.</given-names></name><name xml:lang="ru"><surname>Пристанскова</surname><given-names>Е. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>заведующая отделением гематологии и химиотерапии гемобластозов № 1</p>
<p>Москва</p></bio><email>eprist82@mail.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4532-6613</contrib-id><name-alternatives><name xml:lang="en"><surname>Ponomaryova</surname><given-names>N. I.</given-names></name><name xml:lang="ru"><surname>Пономарева</surname><given-names>Н. И.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>заведующая отделением гематологии и химиотерапии гемобластозов № 2</p>
<p>Москва</p></bio><email>ignata.ponomareva@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-5826-8630</contrib-id><name-alternatives><name xml:lang="en"><surname>Malkova</surname><given-names>O. V.</given-names></name><name xml:lang="ru"><surname>Малкова</surname><given-names>О. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач-гематолог, дневной стационар онкологического и гематологического профиля</p>
<p>Москва</p></bio><email>oxagem@mail.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><name-alternatives><name xml:lang="en"><surname>Blagonravova</surname><given-names>O. L.</given-names></name><name xml:lang="ru"><surname>Благонравова</surname><given-names>О. Л.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач клинической и лабораторной диагностики, отделение трансплантации костного мозга</p>
<p>Москва</p></bio><email>bla-oksana@yandex.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0001-7034-1730</contrib-id><name-alternatives><name xml:lang="en"><surname>Nikolayeva</surname><given-names>Yu. A.</given-names></name><name xml:lang="ru"><surname>Николаева</surname><given-names>Ю. А.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>Moscow</p></bio><bio xml:lang="ru"><p><bold>Юлия Анатольевна Николаева</bold>, врач-трансфузиолог</p><p>отделение трансплантации костного мозга</p><p>Москва</p></bio><email>gussajulia1982@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4170-7152</contrib-id><name-alternatives><name xml:lang="en"><surname>Burya</surname><given-names>A. E.</given-names></name><name xml:lang="ru"><surname>Буря</surname><given-names>А. Е.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач анестезиолог-реаниматолог, отделение трансплантации костного мозга</p>
<p>Москва</p></bio><email>burya.a.e@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-1587-3256</contrib-id><name-alternatives><name xml:lang="en"><surname>Mezentseva</surname><given-names>A. V.</given-names></name><name xml:lang="ru"><surname>Мезенцева</surname><given-names>А. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач-гематолог, отделение трансплантации костного мозга</p></bio><email>mezentseva_a_v@mail.ru</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0002-7531-6443</contrib-id><name-alternatives><name xml:lang="en"><surname>Olkhova</surname><given-names>A. V.</given-names></name><name xml:lang="ru"><surname>Ольхова</surname><given-names>Л. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>врач-онколог, отделение трансплантации костного мозга</p>
<p>Москва</p></bio><email>burya.a.e@gmail.com</email><xref ref-type="aff" rid="aff3"/></contrib><contrib contrib-type="author"><contrib-id contrib-id-type="orcid">https://orcid.org/0000-0003-4431-1444</contrib-id><name-alternatives><name xml:lang="en"><surname>Skorobogatova</surname><given-names>E. V.</given-names></name><name xml:lang="ru"><surname>Скоробогатова</surname><given-names>Е. В.</given-names></name></name-alternatives><address><country country="RU">Russian Federation</country></address><bio xml:lang="en"><p>MD</p></bio><bio xml:lang="ru"><p>заведующая отделением трансплантации костного мозга </p>
<p>Москва</p></bio><email>skorobog.e@mail.ru</email><xref ref-type="aff" rid="aff3"/></contrib></contrib-group><aff-alternatives id="aff1"><aff><institution xml:lang="en">N.I. Pirogov Russian National Research Medical University Immunology of Ministry of Healthcare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff2"><aff><institution xml:lang="en">Ministry of Healthcare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России</institution></aff></aff-alternatives><aff-alternatives id="aff3"><aff><institution xml:lang="en">Russian Children's Clinical Hospital of the N.I. Pirogov Russian National Research Medical University Immunology of Ministry of Healthcare of the Russian Federation</institution></aff><aff><institution xml:lang="ru">Обособленное структурное подразделение Российская детская клиническая больница ФГАОУ ВО «Российский национальный исследовательский медицинский университет им. Н.И. Пирогова» Минздрава России</institution></aff></aff-alternatives><pub-date date-type="pub" iso-8601-date="2022-07-08" publication-format="electronic"><day>08</day><month>07</month><year>2022</year></pub-date><volume>21</volume><issue>2</issue><issue-title xml:lang="en"/><issue-title xml:lang="ru"/><fpage>22</fpage><lpage>31</lpage><history><date date-type="received" iso-8601-date="2022-04-12"><day>12</day><month>04</month><year>2022</year></date><date date-type="accepted" iso-8601-date="2022-04-25"><day>25</day><month>04</month><year>2022</year></date></history><permissions><copyright-statement xml:lang="en">Copyright ©; 2025, «D. Rogachev NMRCPHOI»</copyright-statement><copyright-statement xml:lang="ru">Copyright ©; 2025, ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-statement><copyright-year>2025</copyright-year><copyright-holder xml:lang="en">«D. Rogachev NMRCPHOI»</copyright-holder><copyright-holder xml:lang="ru">ФГБУ «НМИЦ ДГОИ им. Дмитрия Рогачева» Минздрава России</copyright-holder><ali:free_to_read xmlns:ali="http://www.niso.org/schemas/ali/1.0/"/><license><ali:license_ref xmlns:ali="http://www.niso.org/schemas/ali/1.0/">https://creativecommons.org/licenses/by/4.0</ali:license_ref></license></permissions><self-uri xlink:href="https://hemoncim.com/jour/article/view/603">https://hemoncim.com/jour/article/view/603</self-uri><abstract xml:lang="en"><p> Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is a common treatment for a large number of pediatric diseases. Treatment planning is based on a careful selection of patients and donors, taking into account factors contributing to a successful outcome. The aim of our study was to analyze the results of 10 years’ experience in allo-HSCT gained at the Department of Bone Marrow Transplantation of the Russian Children's Clinical Hospital of the N.I. Pirogov Russian National Research Medical University. We retrospectively analyzed 506 patients who had undergone their first allo-HSCTs between January 2010 and December 2020. The study was approved by the Independent Ethics Committee and the Scientific Council of the N.I. Pirogov Russian National Research Medical University of Ministry of Healthcare of the Russian Federation. We included 243 patients who had received allo-HSCT before December 2015 and 263 patients who had received allo-HSCT after January 2016. The gender distribution was 60.1% male (n = 304) and 39.9% female (n = 202). The median age was 7.13 years. Allo-HSCT recipients were divided into two groups: 236 children with non-malignant disease, 270 children with malignant disease. In the malignant group, 89 patients were in first complete remission (CR1), 92 were in second complete remission (CR2), and 20 were in third complete remission (CR3) and beyond; 63 patients had active disease (AD); 6 patients received no prior treatment. Two hundred and twenty patients underwent allo-HSCT from a fully matched family donor (MFD), 172 from a matched unrelated donor (MUD), 33 from a mismatched unrelated donor (MMUD) and 81 from a haploidentical (mismatched) family donor (MMFD). Two hundred and eighty-eight patients received bone marrow as a stem cell source, 208 received peripheral blood stem cells; 10 transplants were performed using umbilical cord blood stem cells. The 5-year overall survival (OS) in the entire cohort was 71.34 %. The 5-year OS in the patients who had undergone allo-HSCT between 2016 and 2020 was higher (p = 0.0014). After 2015, the rates of primary graft failure, the incidence of grade III–IV acute “graft-versus-host” disease (GVHD), and recurrence rates were significantly lower. No difference in the incidence of grade III–IV acute GVHD (p = 0.494) and OS rates (p = 0.138) was seen between different sources of hematopoietic stem cells in the patients who received an HLA-compatible transplant (MFD, MUD). Chronic GVHD was significantly dependent on the severity of acute GVHD and donor type. The 3-year OS rate for the patients in CR1, CR2, ≥ CR3, and AD was 84.4 %, 60.5 %, 56.8 %, and 46 % (p = 0.0034), respectively. The relapse rate of the patients in any remission was lower than of those in active disease (p = 0.015). The transplantation-related mortality in the first 100 days after allo-HSCT was 6.92% (n = 35). The patients who had undergone allo-HSCT after 2015 had lower rates of primary graft failure, a decreased incidence of severe GVHD, improved OS and relapse-free survival rates. The frequency of grade III–IV acute GVHD strongly correlated with HLA compatibility. Chronic GVHD was less frequent in MFD recipients. The risk of chronic GVHD increased with the severity of acute GVHD. The HLA mismatch between a donor and a recipient was associated with a decrease in OS. With each subsequent remission, the OS rate decreased. The risk of recurrence was higher in the patients transplanted in active disease. The results of this study can be used in clinical practice to plan therapy, choose an optimal donor, and develop strategies for the prevention and treatment of complications.</p></abstract><trans-abstract xml:lang="ru"><p><bold> Введение. </bold>Алло-ТГСК является общепринятым методом лечения большого числа заболеваний детей. Планирование терапии основано на тщательном подборе пациентов и доноров, с учетом факторов, способствующих успешному результату.</p> <p><bold> Цель исследования. </bold>Анализ результатов 10-летнего опыта проведения алло-ТГСК в отделении трансплантации костного мозга ОСП «РДКБ» ФГАОУ ВО «Российский национальный исследовательский медицинский университет имени Н.И. Пирогова» Минздрава РФ.</p> <p><bold> Материалы и методы.</bold> Проведен ретроспективный анализ 506 первых алло-ТГСК в период с января 2010 по декабрь 2020 года. 243 пациента до декабря 2015 года, 263 с января 2016 года. 60,1% мальчики (N=304) и 39,9% - девочки (N=202). Медиана возраста 7,13 лет. Две нозологические группы: с неЗНО было 236, с ЗНО 270 детей. В CR1 89 пациентов, во CR2 92, CR3 и последующих 20, 63 получили лечение вне ремиссии, 6 пациентов с ЗНО терапию не получали. 220 алло-ТГСК от MFD, 172 от MUD, 33 от MMUD и 81 от MMFD. У 288 источник был КМ, у 208 ПСК, в 10 случаях ПК.</p> <p><bold> Результаты. </bold>5-летняя ОВ всей когорты составила 71,34%. 5-летняя ОВ с алло-ТГСК в период 2016 – 2020 годы была выше (p=0,0014). После 2015 года статистически значимо реже регистрировались первичное неприживление, оРТПХ 3-4 ст., частота рецидивов. Различий оРТПХ 3-4 ст. (p = 0,494), уровня ОВ (p=0,138), при HLA-совместимых трансплантациях (MFD, MUD), при сравнении источника ГСК не обнаружили. ХрРТПХ статистически значимо зависела от степени оРТПХ, а также типа донора, любого отличного от MFD. Уровень 3-летней ОВ при 1CR 84,4 %, при 2CR 60,5 %, при 3CR и последующей 56,8 %, у пациентов в AD 3-летняя ОВ составляла 46 %, p = 0,0034. Частота рецидивов в любой по счету ремиссии была ниже, чем у пациентов вне ремиссии, p = 0,015. Трансплантатассоциированная смертность в первые 100 дней после алло-ТГСК составила 6,92 % (n=35).</p> <p><bold> Обсуждение.</bold> Было показано снижение частоты первичного неприживления, тяжелых форм РТПХ, повышение уровня ОВ, БРВ у пациентов, которым ТГСК проведена после 2015 года. Частота регистрации оРТПХ 3-4 ст. имеет сильную корреляцию с HLA- совместимостью. ХрРТПХ реже всего регистрировалось при MFD. Риск развития хрРТПХ увеличивается по мере усиления тяжести оРТПХ. HLA-несоответствие между донором и реципиентом ассоциировалось со снижением уровня ОВ. С каждой последующей ремиссией регистрируется снижение ОВ, риск рецидивов выше у пациентов, трансплантированных вне ремиссии. Выводы настоящего исследования могут быть использованы в клинической практике для планирования терапии, подбора оптимального донора, стратегии профилактики и лечения осложнений. </p></trans-abstract><kwd-group xml:lang="en"><kwd>unrelated donor</kwd><kwd>oncohematological diseases</kwd><kwd>allogeneic hematopoietic stem cell transplantation</kwd><kwd>primary immunodeficiencies</kwd><kwd>“graft-versus-host” disease</kwd></kwd-group><kwd-group xml:lang="ru"><kwd>неродственный донор</kwd><kwd>гематология</kwd><kwd>онкология</kwd><kwd>трансплантация и клеточные технологии</kwd><kwd>первичные иммунодефициты</kwd><kwd>РТПХ</kwd></kwd-group><funding-group><funding-statement xml:lang="en">Not specified</funding-statement><funding-statement xml:lang="ru">Не указан</funding-statement></funding-group></article-meta></front><body></body><back><ref-list><ref id="B1"><label>1.</label><citation-alternatives><mixed-citation xml:lang="en">1. Алянский А.Л. 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