Department of Medicine (Division of Hematology and Oncology) and Stem Cell Transplant Program, University Hospitals Seidman Center and Case Western Reserve University, Cleveland, OH, USA.
Drugs Aging. 2013 Jun;30(6):373-81. doi: 10.1007/s40266-013-0076-x.
Allogeneic stem cell transplantation (SCT) is a potentially curative treatment for patients with hematological malignancies. These diseases, however, have their peak incidence in the sixth to eighth decades of life. Historically, elderly patients have been considered unsuitable candidates for SCT because of high treatment-related mortality (TRM). Over the past 15 years, the use of reduced-intensity conditioning (RIC) regimens before SCT has allowed patients in the sixth and seventh decades of life to be routinely transplanted. Despite major differences among transplant centers in the intensity and composition of the conditioning regimen and immunosuppression, choice of graft source, postgraft immunomodulation, and supportive care, there has been a dramatic decrease in TRM, allowing safer delivery of SCT. Major obstacles to SCT in elderly patients include donor availability, graft-versus-host disease, delayed immune recovery, multiple comorbidities, and chemo refractoriness. Here we review the current results of SCT in elderly patients, focusing on the role of RIC, and using myeloid diseases as the model for discussion.
异基因造血干细胞移植（SCT）是治疗血液系统恶性肿瘤患者的一种潜在治愈方法。然而，这些疾病的高发年龄段为第六至第八个十年。历史上，由于治疗相关死亡率（TRM）高，老年患者被认为不适合接受 SCT。在过去的 15 年中，SCT 前采用低强度预处理（RIC）方案使得第六和第七个十年的患者能够常规进行移植。尽管移植中心之间在预处理方案和免疫抑制的强度和组成、移植物来源的选择、移植后免疫调节以及支持性护理方面存在重大差异，但 TRM 显著降低，从而能够更安全地进行 SCT。老年患者 SCT 的主要障碍包括供体可用性、移植物抗宿主病、免疫恢复延迟、多种合并症和化疗耐药。在这里，我们回顾了老年患者 SCT 的当前结果，重点介绍了 RIC 的作用，并以髓系疾病作为讨论模型。
