Cell Therapy Centre & Department of Medicine, Faculty of Medicine, Universiti Kebangsaan Malaysia (UKM) Medical Center, Jalan Yaacob Latif, Bandar Tun Razak, 56000 Cheras, Kuala Lumpur, Malaysia.
Stem Cell Rev Rep. 2012 Dec;8(4):1254-64. doi: 10.1007/s12015-012-9401-8.
Allogeneic hematopoietic stem cell transplantation (HSCT) remains a potential curative option for many patients with hematological malignancies (HM). However, the high rate of transplantation-related mortality (TRM) restricted the use of standard myeloablative HSCT to a minority of young and fit patients. Over the past few years, it has become evident that the alloreactivity of the immunocompetent donor cells mediated anti-malignancy effects independent of the action of high dose chemoradiotherapy. The use of reduced intensity conditioning (RIC) regimens has allowed a graft-versus-malignancy (GvM) effect to be exploited in patients who were previously ineligible for HSCT on the grounds of age and comorbidity. Retrospective analysis showed that RIC has been associated with lower TRM but a higher relapse rate leading to similar intermediate term overall and progression-free survivals when compared to standard myeloablative HSCT. However, the long term antitumor effect of this approach is less well established. Prospective studies are ongoing to define which patients might most benefit from reduced toxicity stem cell transplant (RT-SCT) and which transplant protocols are suitable for the different types of HM. The advent of RT-SCT permits the delivery of a potentially curative GvM effect to the majority of patients with HM whose outcome with conventional chemotherapy would be dismal. Remaining challenges include development of effective strategies to reduce relapse rates by augmenting GvM effects without increasing toxicity.
异基因造血干细胞移植（HSCT）仍然是许多血液恶性肿瘤（HM）患者的潜在治愈选择。然而，高移植相关死亡率（TRM）限制了标准清髓性 HSCT 仅在少数年轻和健康的患者中使用。在过去的几年中，免疫活性供体细胞的同种异体反应独立于高剂量化疗和放疗的作用介导抗恶性肿瘤效应已变得明显。使用强度降低的调理（RIC）方案使得可以在以前因年龄和合并症而不适合 HSCT 的患者中利用移植物抗恶性肿瘤（GvM）效应。回顾性分析表明，RIC 与较低的 TRM 相关，但复发率较高，与标准清髓性 HSCT 相比，导致中期总生存率和无进展生存率相似。然而，这种方法的长期抗肿瘤效果尚未得到充分证实。正在进行前瞻性研究，以确定哪些患者可能从降低毒性干细胞移植（RT-SCT）中获益最大，以及哪些移植方案适合不同类型的 HM。RT-SCT 的出现允许将潜在的治愈性 GvM 效应传递给大多数 HM 患者，而这些患者如果采用常规化疗则预后不佳。仍然存在的挑战包括开发有效的策略，通过增强 GvM 效应而不增加毒性来降低复发率。
