Diaconescu Razvan, Storb Rainer
Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
J Cancer Res Clin Oncol. 2005 Jan;131(1):1-13. doi: 10.1007/s00432-004-0611-6. Epub 2004 Sep 28.
For more than half a century, researchers have explored myeloablative, high-dose chemo/radiotherapy followed by allogeneic hematopoietic stem cell transplantation (HCT) for therapy of malignant and nonmalignant hematological diseases. Continuous advances in the field have changed this approach from one that was initially thought to be fraught by insurmountable complications to one that is now considered standard therapy for many diseases.
In order to extend allogeneic HCT to include elderly patients, who represent the main population affected by hematological malignancies, and to those who are medically unfit to undergo conventional HCT, novel non-myeloablative approaches have been developed. These approaches rely on graft-vs-tumor effects for tumor eradication rather than high-dose chemoradiotherapy, and, accordingly, have lower toxicities than conventional regimens.
Results with non-myeloablative regimens have been gratifying, and this may change the future of allogeneic HCT. Advances could not have been possible without basic research and studies in pre-clinical animal models.
Further work is focused on improving graft-vs-tumor effects while achieving better control of graft-vs-host disease.
半个多世纪以来，研究人员一直在探索采用清髓性大剂量化疗/放疗，随后进行异基因造血干细胞移植（HCT）来治疗恶性和非恶性血液疾病。该领域的不断进步已使这种治疗方法从最初被认为充满不可克服并发症的方式，转变为如今被视为许多疾病标准治疗的方法。
为了将异基因HCT扩展至包括老年患者（血液系统恶性肿瘤的主要患病人群）以及那些因身体状况不适合接受传统HCT的患者，人们开发了新型非清髓性方法。这些方法依靠移植物抗肿瘤效应来根除肿瘤，而非大剂量放化疗，因此，其毒性低于传统治疗方案。
非清髓性治疗方案的结果令人满意，这可能会改变异基因HCT的未来。如果没有基础研究和临床前动物模型研究，这些进展是不可能实现的。
进一步的工作重点是在更好地控制移植物抗宿主病的同时，提高移植物抗肿瘤效应。
