Storb Rainer
Fred Hutchinson Cancer Research Center, Clinical Research Division, Transplantation Biology Program, Fairview Avenue North, D5-310, PO Box 19024, Seattle, WA 98109-1024, USA.
Best Pract Res Clin Haematol. 2007 Mar;20(1):85-90. doi: 10.1016/j.beha.2006.10.008.
Development of nonablative and reduced-intensity conditioning regimens has enabled older or medically infirm patients with myeloid malignancies to be treated with allogeneic hematopoietic cell transplantation (HCT). These regimens rely largely on graft-versus-leukemia effects rather than high-dose therapy to eliminate malignant cells. Studies indicate that there is sustained engraftment with relatively low transplant-related mortality in the small number of patients who have been treated. This review summarizes the outcome in recent studies of patients with myeloid malignancies who received HCT following nonmyeloablative or reduced-intensity conditioning. Comparison of nonmyeloablative with myeloablative transplant shows that the myeloablative patients are about 10-15 years younger. Toxicity is a major problem in the elderly who have comorbid conditions, but otherwise the patient has a similar outcome, again emphasizing the graft-versus-leukemia effect. Comparison of patients receiving related or unrelated grafts following nonmyeloablative conditioning shows that the outcome in these patients is similar. These studies have demonstrated encouraging overall survival and nonrelapse mortalities with evidence for graft-versus-leukemia responses in elderly patients with hematologic malignancies. Relapse and progressive disease continued to be problems, particularly in patients with large tumor burdens at time of HCT. Elimination of tumor burden prior to transplant with immunotherapy such as with radiolabeled anti-CD45 antibody or vaccines may improve outcome further.
非清髓性和减低强度预处理方案的发展，使患有髓系恶性肿瘤的老年患者或身体状况较差的患者能够接受异基因造血细胞移植（HCT）治疗。这些方案主要依靠移植物抗白血病效应，而非大剂量化疗来清除恶性细胞。研究表明，在少数接受治疗的患者中，移植相关死亡率相对较低，且能实现持续植入。本综述总结了近期对接受非清髓性或减低强度预处理后进行HCT的髓系恶性肿瘤患者的研究结果。非清髓性移植与清髓性移植的比较显示，清髓性移植患者的年龄要小10 - 15岁左右。毒性是患有合并症的老年患者的一个主要问题，但除此之外，患者的预后相似，这再次强调了移植物抗白血病效应。对接受非清髓性预处理后接受相关或无关供体移植的患者进行比较显示，这些患者的预后相似。这些研究表明，老年血液系统恶性肿瘤患者的总生存率和非复发死亡率令人鼓舞，且有移植物抗白血病反应的证据。复发和疾病进展仍然是问题，尤其是在HCT时肿瘤负荷较大时的患者。在移植前用免疫疗法如放射性标记的抗CD45抗体或疫苗消除肿瘤负荷，可能会进一步改善预后。
