Jiménez M, Ercilla G, Martínez C
Department of Hematology, Institute of Hematology and Oncology, Institut d'Investigacions Biomèdiques August Pi I Sunyer, IDIBAPS, Hospital Clínic, University of Barcelona, Barcelona, Spain.
Leukemia. 2007 Aug;21(8):1628-37. doi: 10.1038/sj.leu.2404681. Epub 2007 May 24.
Reduced-intensity conditioning (RIC) regimens have been increasingly used as an alternative to conventional myeloablative conditioning (MAC) regimens for elderly patients, for patients medically infirm to qualify for conventional allogeneic stem cell transplantation (SCT), and for disorders in which traditional MAC-SCT are associated with high rates of non-relapse mortality. One of the theoretical advantages of RIC-SCT is that it might lend to better immune reconstitution after transplantation due to less damage of the thymus, allowing regeneration of naive T cells derived from prethymic donor stem cells, and due to the proliferation of immunologically competent host T cells that survive the conditioning regimen. Although limited, studies comparing immune recovery following RIC and MAC-SCT have been insightful. One of the main difficulties of these studies is the current spectrum of RIC protocols, which vary considerably in myeloablative and immunosuppressive potential, resulting in apparently contradictory findings. In spite of this, most reports have shown significant quantitative and/or qualitative differences in T- and B-cell reconstitution after RIC-SCT in comparison with conventional SCT. This paper will review current knowledge of immune reconstitution following RIC-SCT.
低强度预处理（RIC）方案已越来越多地被用作传统清髓性预处理（MAC）方案的替代方案，用于老年患者、因身体状况不佳而不符合传统异基因干细胞移植（SCT）条件的患者，以及传统MAC-SCT与高非复发死亡率相关的疾病。RIC-SCT的理论优势之一是，由于对胸腺的损伤较小，它可能有助于移植后更好的免疫重建，从而使源自胸腺前供体干细胞的幼稚T细胞得以再生，并且由于在预处理方案中存活下来的具有免疫活性的宿主T细胞的增殖。尽管相关研究有限，但比较RIC和MAC-SCT后免疫恢复情况的研究还是很有启发性的。这些研究的主要困难之一是目前的RIC方案范围，其在清髓和免疫抑制潜力方面差异很大，导致结果明显相互矛盾。尽管如此，大多数报告显示，与传统SCT相比，RIC-SCT后T细胞和B细胞重建存在显著的数量和/或质量差异。本文将综述目前关于RIC-SCT后免疫重建的知识。
