Champlin R, Khouri I, Komblau S, Molidrem J, Giralt S
Department of Blood and Marrow Transplantation, University of Texas M. D. Anderson Cancer Center, Houston, USA.
Oncology (Williston Park). 1999 May;13(5):621-8; discussion 631, 635-8, 641.
The therapeutic benefit of allogeneic hematopoietic transplantation is due largely to an immune graft-vs-malignancy effect. Most of the evidence for such an effect has come from studies of allogeneic transplantation in leukemia. In patients with susceptible malignancies who relapse following an allogeneic transplant, infusion of donor lymphocytes can induce durable remissions. Use of less toxic, nonmyeloablative preparative regimens permits engraftment and generation of graft-vs-malignancy effects. This strategy permits allogeneic transplantation to be used in older patients and those with comorbidities who cannot tolerate conventional high-dose preparative regimens. The long-term efficacy of nonmyeloablative preparative regimens and induction of graft-vs-malignancy effects remains to be determined. Also, further clinical trials are required to address various unresolved issues and to compare this strategy with standard, myeloablative transplantation regimens.
异基因造血移植的治疗益处很大程度上归因于免疫移植物抗恶性肿瘤效应。这种效应的大多数证据来自白血病异基因移植研究。在异基因移植后复发的易感性恶性肿瘤患者中，输注供体淋巴细胞可诱导持久缓解。使用毒性较小的非清髓性预处理方案可实现植入并产生移植物抗恶性肿瘤效应。该策略使异基因移植可用于老年患者以及无法耐受传统高剂量预处理方案的合并症患者。非清髓性预处理方案的长期疗效以及移植物抗恶性肿瘤效应的诱导仍有待确定。此外，还需要进一步的临床试验来解决各种未解决的问题，并将该策略与标准的清髓性移植方案进行比较。
