Peking University People's Hospital, Peking University Institute of Hematology, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Beijing, China.
Curr Opin Hematol. 2012 Nov;19(6):454-61. doi: 10.1097/MOH.0b013e3283582322.
This article summarizes recent improvements and progress with unmanipulated haploidentical blood and marrow transplantation (HBMT) and discusses the difference in outcomes between patients receiving HBMT and those receiving unmanipulated granulocyte colony stimulating factor (G-CSF) mobilized haploidentical peripheral blood (G-PB) grafts as allografts.
Long-term follow-up confirmed that unmanipulated HBMT is a promising protocol that can be successfully extended to treat severe aplastic anemia. Recent observations regarding immune recovery, infections, and strategy for modified donor lymphocyte infusions have provided insight into the prevention of infections and the decrease in relapse after HBMT. Extensive chronic graft-versus-host disease (GVHD) strongly and negatively impacts patient health-related quality of life, suggesting that it should be successfully controlled. A prospective study suggested the inclusion of HBMT in treatment algorithms as a viable option for adults with acute myeloid leukemia with unfavorable cytogenetics who lack a matched donor. Randomized clinical trials are warranted to investigate whether mixture grafts of G-CSF-mobilized blood and marrow or G-PB alone should be chosen as allografts in haploidentical settings.
Unmanipulated HBMT is a reliable protocol. New strategies should be investigated to decrease the incidences of GVHD and relapse. Novel mobilization regimens such as AMD3100 alone or G-CSF+AMD3100 for allograft engineering may improve transplant outcomes following HBMT.
本文总结了未经处理的单倍体血缘和骨髓移植（HBMT）的最新进展和改进，并讨论了接受 HBMT 和接受未经处理的粒细胞集落刺激因子（G-CSF）动员的单倍体外周血（G-PB）移植物作为同种异体移植物的患者之间的结果差异。
长期随访证实，未经处理的 HBMT 是一种很有前途的方案，可以成功扩展用于治疗严重再生障碍性贫血。最近关于免疫恢复、感染和改良供者淋巴细胞输注策略的观察结果为预防感染和减少 HBMT 后复发提供了线索。广泛的慢性移植物抗宿主病（GVHD）强烈且负面影响患者的健康相关生活质量，表明应成功控制。一项前瞻性研究表明，将 HBMT 纳入治疗算法作为缺乏匹配供体的伴有不良细胞遗传学的成人急性髓细胞白血病的可行选择。需要进行随机临床试验，以研究在单倍体环境中，是否应该选择 G-CSF 动员的血液和骨髓混合物移植物或单独的 G-PB 作为同种异体移植物。
未经处理的 HBMT 是一种可靠的方案。应研究新策略来降低 GVHD 和复发的发生率。新型动员方案，如单独使用 AMD3100 或 G-CSF+AMD3100 进行同种异体移植物工程，可能会改善 HBMT 后的移植结果。
