Kumar Lalit
Department of Medical Oncology, Institute Rotary Cancer Hospital, All India Institute of Medical Sciences, New Delhi 110029, India.
Natl Med J India. 2007 May-Jun;20(3):128-37.
Haematopoietic stem cell transplantation (HSCT) is now an established treatment fora number of non-malignant and malignant conditions. Bone marrow- or peripheral blood-derived allogeneic SCT from an HLA-identical sibling or matched unrelated donor cures more than half the patients with severe aplastic anaemia, thalassaemia major, congenital immunodeficiency diseases and genetic metabolic disorders. Among the malignant conditions, acute and chronic leukaemia, multiple myeloma, Hodgkin and non-Hodgkin lymphoma, and high risk neuroblastoma are important conditions that can be treated by HSCT. The major morbidities associated with HSCT are regimen-related toxicities, development of acute or chronic graft-versus-host disease (GVHD), failure of engraftment of the bone marrow and complications related to the immunodeficiency that occurs in the post-transplant period. Peripheral blood stem cells are now being used as an alternative to bone marrow stem cells for allogeneic HSCT and exclusively for autologous HSCT. Reduced intensity conditioning for allogeneic HSCT has resulted in a lower frequency and severity of GVHD and risk of infections. This has resulted in allogeneic HSCT being done in older patients and for those with co-morbid conditions. Patients with low grade Hodgkin and non-Hodgkin lymphoma, chronic lymphocytic leukaemia and multiple myeloma appear to benefit more with this approach. Prevention of acute GVHD while maintainingthe graft-versus-tumour effect and close monitoring of the kinetics of chimerism hold promise for improving the outcome of those receiving reduced intensity allogeneic HSCT. In recipients ofautologous HSCT, identification of patients at increased risk for relapse and use of agents (interferon, interleukin-2) post-transplant to augment the graft-versus-tumour effect are possible areas of further research.
造血干细胞移植（HSCT）现已成为多种非恶性和恶性疾病的既定治疗方法。来自 HLA 相同的同胞或匹配的无关供体的骨髓或外周血来源的异基因 SCT 可治愈超过一半的重型再生障碍性贫血、重型地中海贫血、先天性免疫缺陷疾病和遗传代谢紊乱患者。在恶性疾病中，急性和慢性白血病、多发性骨髓瘤、霍奇金淋巴瘤和非霍奇金淋巴瘤以及高危神经母细胞瘤是可通过 HSCT 治疗的重要疾病。与 HSCT 相关的主要并发症是与方案相关的毒性、急性或慢性移植物抗宿主病（GVHD）的发生、骨髓植入失败以及移植后发生的免疫缺陷相关并发症。外周血干细胞现在正被用作异基因 HSCT 的骨髓干细胞替代物，并专门用于自体 HSCT。异基因 HSCT 的减低强度预处理导致 GVHD 的发生率和严重程度以及感染风险降低。这使得异基因 HSCT 能够在老年患者和有合并症的患者中进行。低度霍奇金淋巴瘤和非霍奇金淋巴瘤、慢性淋巴细胞白血病和多发性骨髓瘤患者似乎从这种方法中获益更多。在维持移植物抗肿瘤效应的同时预防急性 GVHD 以及密切监测嵌合体动力学有望改善接受减低强度异基因 HSCT 患者的预后。在自体 HSCT 受者中，识别复发风险增加的患者以及移植后使用药物（干扰素、白细胞介素 -2）增强移植物抗肿瘤效应是可能的进一步研究领域。
