University of Minnesota, Minneapolis, Minnesota, USA.
Curr Opin Hematol. 2010 Mar;17(2):133-8. doi: 10.1097/MOH.0b013e3283366ba4.
We reviewed reduced-intensity hematopoietic cell transplantation for older patients in the context of recently published studies.
Most studies describe applicability of reduced-intensity transplantation to older patients with overall survival rates that compare favorably to chemotherapy alone, though relapse and graft-versus-host disease remain complicating factors. Though transplant recipients likely represent a highly selected population, current studies do not demonstrate an upper age for transplantation and suggest that myeloablative regimens may be considered in older patients with limited comorbidities. Avenues being pursued to improve transplant outcomes include natural killer cell immunotherapy and regulatory T-cell modulation.
Until prospective studies show otherwise, transplant conditioning intensity for the older patient should be based on individual patient and disease characteristics. Enrollment into clinical trials is paramount in efforts to reduce transplant-related mortality and improve outcomes.
我们回顾了在最近发表的研究背景下，对老年患者进行低强度造血细胞移植的情况。
大多数研究表明，低强度移植适用于总体生存率与单纯化疗相比有优势的老年患者，但复发和移植物抗宿主病仍然是复杂因素。尽管移植受者可能代表了一个高度选择的人群，但目前的研究并没有确定移植的最高年龄，并表明对于合并症有限的老年患者，可以考虑使用清髓性方案。为了改善移植结果，目前正在探索自然杀伤细胞免疫治疗和调节性 T 细胞调节等途径。
在前瞻性研究表明相反之前，老年患者的移植预处理强度应基于患者个体和疾病特征。参与临床试验对于降低移植相关死亡率和改善结果至关重要。
