Giralt S
Department of Blood and Marrow Transplantation of the University of Texas M.D. Anderson Cancer Center, Houston, USA.
Int J Hematol. 2002 Aug;76 Suppl 1:368-75.
Allogeneic stem cell transplantation is an established treatment modality for a variety of hematologic malignancies. Unfortunately it carries a high risk of complications and toxicities related to the intensive preparative regimen which is traditionally used for pre-transplant myeloablation and the graft versus host disease, which may be life threatening. Thus allogeneic stem cell transplantation has been used only for younger patients with a good performance status, excluding many other potential candidates due to advanced age or comorbid conditions. Non ablative or reduced intensity preparative regimens for allogeneic stem cell transplantation (NST) have been proposed as a strategy that would allow exploiting the graft versus tumor effect of allogeneic transplantation without the toxicity of myeloablative therapy. After more than five years of cumulative clinical experience, it is now well established that NST is a feasible treatment option for patients with suboptimal performance status and is mostly effective in slow proliferating malignancies, which gives time for a graft versus malignancy effect to take place. Additionally achievement of stable donor cell engraftment with NSTs provides a platform for adoptive immune cell treatments and may allow to extend indications of stem cell transplantation in the future.
异基因干细胞移植是治疗多种血液系统恶性肿瘤的一种成熟治疗方式。不幸的是，它具有与强化预处理方案相关的高并发症和毒性风险，传统上该方案用于移植前的骨髓清除以及移植物抗宿主病，这可能危及生命。因此，异基因干细胞移植仅用于身体状况良好的年轻患者，许多因年龄较大或合并症而成为潜在候选者的患者被排除在外。异基因干细胞移植的非清髓或减低强度预处理方案（NST）已被提出，作为一种策略，该策略可以利用异基因移植的移植物抗肿瘤效应，而不产生清髓性治疗的毒性。经过五年多的累积临床经验，现在已经明确，NST对于身体状况欠佳的患者是一种可行的治疗选择，并且在增殖缓慢的恶性肿瘤中大多有效，可以为移植物抗肿瘤效应的发生留出时间。此外，NST实现稳定的供体细胞植入为过继性免疫细胞治疗提供了一个平台，并可能在未来扩大干细胞移植的适应症。
