Espérou Hélène
Service d'hématologie-greffe de moelle, hôpital Saint-Louis, 75475 Paris Cedex 10, France.
Rev Prat. 2008 Dec 15;58(19):2130-6.
The therapeutic use of the hematopoïetic stem cells (HSC) has been limiting until recently at the bone marrow transplantation whatever the type of graft: autologous or allogeneic. Since two decades, the advances in the characterization of these stem cells and the development of new harvesting possibilities for a therapeutic use lead to the replacement of the basic: bone marrow graft by the more sophisticated. In 2007, in France, 4239 HSC transplantations were performed (2860 autologous ones and 1379 allogeneic ones); in Europe, in 2006, 25,050 grafts were performed in which 61% were autologous and 39% allogeneic. The number of autografts remains stable. The increasement of the allogeneic grafts is due to the larger possibilities to find an allogeneic donor beyond the siblings (unrelated donor, cord blood unit) and the changes in the transplant modalities (reduced intensity conditioning regimen) which allow to allograft older patients. The improvements in the biological field and in clinical practice take into account the better results and the better definition of the grafts indications. The recent works about the HSC differentiation capacity into differentiated cells which are not only blood cells, open advanced perspectives in the young medicine so-called "regenerative one" especially in the field of cardio-vascular diseases, musculo-skeletal and neurologic diseases.
直到最近,无论移植类型是自体还是异体,造血干细胞(HSC)在骨髓移植中的治疗应用一直受到限制。二十年来,这些干细胞特征鉴定方面的进展以及用于治疗的新采集方法的发展,使得更为先进的方法取代了传统的骨髓移植。2007年,法国进行了4239例造血干细胞移植(2860例自体移植和1379例异体移植);2006年在欧洲,进行了25050例移植,其中61%为自体移植,39%为异体移植。自体移植的数量保持稳定。异体移植数量的增加是由于除了同胞之外找到异体供体的可能性更大(无关供体、脐血单位)以及移植方式的改变(减低预处理强度方案),这使得老年患者也能进行异体移植。生物学领域和临床实践的进步考虑到了更好的结果以及对移植适应证更明确的定义。最近关于造血干细胞向不仅是血细胞的分化细胞分化能力的研究,为所谓的“再生医学”这一年轻医学领域,尤其是在心血管疾病、肌肉骨骼疾病和神经疾病领域,开辟了广阔的前景。