Bacigalupo A
Divisione Ematologia 2, Ospedale San Martino, Genova, Italy.
Bone Marrow Transplant. 2004 Apr;33(7):691-6. doi: 10.1038/sj.bmt.1704416.
The Third Workshop on reduced intensity conditioning allogeneic stem cell transplants (RIC-HSCT) was convened by EBMT/AMGEN in Zurich in February 2003. Three general issues were addressed: the age effect, graft-versus-host disease (GvHD) and donor lymphocyte infusions (DLI). An age effect is seen and has a negative impact on survival; GvHD remains an issue that needs to be addressed, and DLI were shown to be a powerful tool against minimal residual disease, but not with rapidly progressing leukemia. The role of host antigen-presenting cells in the development of acute GvHD was outlined and discussed in the animal model. The emerging importance of Epstein Barr Virus infections was also discussed. Retrospective and prospective studies from the EBMT, national groups and single institutions included over 1800 patients: the incidence of acute GvHD grade III-IV was 11% extensive chronic GvHD 22% and TRM 20%. Most conditioning regimens include fludarabine in association with a reduced dose of a myeloablative agent (busulfan, TBI, thiotepa or melphalan). Most transplants were from HLA-identical siblings (77%), and used peripheral blood (90%) as a stem cell source. A consensus discussion on current evidence in RIC transplants is reported in this paper.
2003年2月，欧洲血液与骨髓移植协会（EBMT）/安进公司在苏黎世召开了第三届减低强度预处理异基因干细胞移植（RIC-HSCT）研讨会。会议讨论了三个主要问题：年龄效应、移植物抗宿主病（GvHD）和供体淋巴细胞输注（DLI）。年龄效应已被观察到，且对生存率有负面影响；GvHD仍然是一个需要解决的问题，DLI被证明是对抗微小残留病的有力工具，但对快速进展的白血病无效。在动物模型中概述并讨论了宿主抗原呈递细胞在急性GvHD发生中的作用。还讨论了爱泼斯坦-巴尔病毒感染日益凸显的重要性。来自EBMT、国家研究小组和单一机构的回顾性和前瞻性研究纳入了1800多名患者：急性GvHD III-IV级的发生率为11%，广泛性慢性GvHD为22%，移植相关死亡率为20%。大多数预处理方案包括氟达拉滨联合降低剂量的清髓性药物（白消安、全身照射、噻替派或美法仑）。大多数移植来自HLA匹配的同胞（77%），并使用外周血（90%）作为干细胞来源。本文报道了关于RIC移植当前证据的共识讨论。
