Fondazione Policlinico "Tor Vergata", Rome, Italy.
Best Pract Res Clin Haematol. 2010 Jun;23(2):197-206. doi: 10.1016/j.beha.2010.05.007.
Allogeneic haematopoietic stem cell transplantation represents a potential life-saving procedure for many patients affected by acute myeloid leukaemia. However, in the past its application has been limited by the availability of a HLA matched sibling. To date, an allogeneic transplant from alternative haematopoietic stem cell sources (volunteer unrelated donor, umbilical cord blood, haploidentical family donor) should be considered for all patients with high-risk disease defined by integration of clinical and biological prognosticators. In this context, following the preliminary, encouraging results, the transplant of unrelated umbilical cord blood has been progressively increased because of its prompt availability and a more permissive HLA incompatibility between donor and recipient. Furthermore, the decreased risk of GVHD, the use of reduced intensity conditionings and the graft of double cord blood units permit to extend cord blood transplant to a higher proportion of adult patients with acute myeloid leukaemia, which is predominantly diagnosed in the elderly age. A multicentric, prospective intention-to-treat study is warranted in order to define which haematopoietic stem cell source represents the best choice for allogeneic transplant in high-risk acute myeloid leukaemia.
异基因造血干细胞移植代表了许多急性髓系白血病患者潜在的救命程序。然而，过去其应用受到 HLA 匹配的同胞供体可用性的限制。迄今为止，对于所有高危疾病患者，都应考虑来自替代造血干细胞来源（志愿无关供体、脐带血、单倍体家族供体）的异基因移植，这些患者的高危疾病是通过整合临床和生物学预后因素来定义的。在这种情况下，由于其快速可用性以及供体和受体之间更宽松的 HLA 不相容性，在初步取得令人鼓舞的结果后，无关脐带血移植的应用逐渐增加。此外，降低移植物抗宿主病的风险、采用强度降低的预处理和双脐带血单位的移植，使得更多的急性髓系白血病成年患者可以接受脐带血移植，而急性髓系白血病主要在老年患者中诊断。为了确定在高危急性髓系白血病中哪种造血干细胞来源是异基因移植的最佳选择，需要进行一项多中心、前瞻性意向治疗研究。
