IRCCS Ospedale Pediatrico Bambino Gesù, Department of Pediatric Oncology and Hematology , Piazza Sant'Onofrio 4, 00165 Rome , Italy +39 06 68592678 ; +39 06 68592292 ;
Expert Opin Pharmacother. 2014 Jan;15(1):23-36. doi: 10.1517/14656566.2014.852537. Epub 2013 Oct 25.
One significant obstacle to the success of allogeneic hematopoietic stem cell transplantation (HSCT) is represented by graft failure, defined as either lack of initial engraftment of donor cells (primary graft failure) or loss of donor cells after initial engraftment (secondary graft failure). Graft failure mediated by host immune cells attacking donor stem cells is named graft rejection. Factors associated with graft failure include HLA disparity in the donor/recipient pair, underlying disease, viral infections, type of conditioning regimen and stem cell source employed.
In this article, the experts summarize current approaches to treat graft failure/rejection after HSCT, and they discuss new strategies of graft manipulation and immune therapy of particular interest for preventing/treating this complication.
A limited array of options is available to treat graft failure. The experts believe that re-transplantation from another donor or the same donor (if there is no evidence of immunologically mediated graft failure) is the treatment of choice for patients with primary graft failure or acute graft rejection. The experts think that strategies based on innovative approaches of graft manipulation, new agents or cellular therapies could render in the future graft failure a much less relevant problem for HSCT recipients.
同种异体造血干细胞移植（HSCT）成功的一个主要障碍是移植物失败，定义为供体细胞缺乏初始植入（原发性移植物失败）或初始植入后供体细胞丢失（继发性移植物失败）。由宿主免疫细胞攻击供体干细胞引起的移植物失败称为移植物排斥。与移植物失败相关的因素包括供体/受者对 HLA 差异、基础疾病、病毒感染、预处理方案类型和所使用的干细胞来源。
本文中，专家总结了目前治疗 HSCT 后移植物失败/排斥的方法，并讨论了特别关注的用于预防/治疗这种并发症的移植物处理和免疫治疗的新策略。
治疗移植物失败的选择有限。专家认为，对于原发性移植物失败或急性移植物排斥的患者，另一个供体或同一供体（如果没有免疫介导的移植物失败证据）的再次移植是首选治疗方法。专家认为，基于创新的移植物处理方法、新药物或细胞疗法的策略可能会使未来的移植物失败对 HSCT 受者不再是一个重要问题。
