Hilgendorf Inken, Greinix Hildegard, Halter Jörg P, Lawitschka Anita, Bertz Hartmut, Wolff Daniel
Clinic of Internal Medicine II, University Hospital Jena, University Clinic of Internal Medicine I, Medical University of Vienna, Austria, Department of Hematology, University Hospital of Basel, St. Anna Children's Hospital, Vienna, Austria, Department of Hematology, Oncology, and Stem-Cell Transplantation, Medical Center - University of Freiburg, Department of Internal Medicine III, University Hospital Regensburg.
Dtsch Arztebl Int. 2015 Jan 23;112(4):51-8. doi: 10.3238/arztebl.2015.0051.
Over 3000 persons undergo allogeneic hematopoietic stem-cell transplantation (allo-HSCT) in Germany every year. Advances in allo-HSCT have prolonged the survival of treated patients but have concomitantly increased the risk of long-term complications that impair their quality of life.
This literature review of the long-term sequelae of allo-HSCT is based on pertinent articles that were retrieved by a selective search of PubMed, and on current international guidelines. Case reports were excluded from consideration.
Hardly any randomized clinical trials have been performed to investigate the long-term outcome of allo-HSCT, but international consensus-based guidelines have been published. 50% to 70% of patients treated with allo-HSCT develop chronic graft-versus-host disease (cGVHD) within ten years of treatment. Transplant recipients are at higher risk of infection, including the reactivation of dormant herpes viruses; therefore, vaccination is recommended, as described in the current guidelines. Gonadal dysfunction arises in up to 92% of men and up to 99% of women; its frequency depends on the timing of transplantation, on radiotherapy, and on other factors. The medications that transplant recipients need to take can impair liver function, and transfusionassociated hemosiderosis can do so as well. 40% to 50% of patients suffer from lipid metabolic disturbances that increase the risk of myocardial infarction, peripheral arterial occlusive disease, and stroke. Their life expectancy is shorter than that of the overall population.
Measures should be taken to prevent the potential long-term complications of allo-HSCT. All patients who have been treated with allo-HSCT should receive individualized, risk-adapted, and multidisciplinary follow-up care, so that any complications that arise can be correctly diagnosed and appropriately treated. Long-term follow-up care could be improved by prospective clinical trials investigating the long-term sequelae of allo-HSCT, as well as by consistent, uniform documentation of these sequelae in supraregional data registries.
在德国，每年有超过3000人接受异基因造血干细胞移植（allo-HSCT）。异基因造血干细胞移植技术的进步延长了接受治疗患者的生存期，但同时也增加了长期并发症的风险，这些并发症会损害他们的生活质量。
这篇关于异基因造血干细胞移植长期后遗症的文献综述基于通过对PubMed进行选择性检索获取的相关文章以及当前的国际指南。病例报告不纳入考虑范围。
几乎没有进行过随机临床试验来研究异基因造血干细胞移植的长期结局，但已发布了基于国际共识的指南。接受异基因造血干细胞移植治疗的患者中有50%至70%会在治疗后十年内发生慢性移植物抗宿主病（cGVHD）。移植受者感染风险更高，包括潜伏性疱疹病毒的重新激活；因此，按照当前指南的描述，建议进行疫苗接种。高达92%的男性和高达99%的女性会出现性腺功能障碍；其发生率取决于移植时间、放疗及其他因素。移植受者所需服用的药物会损害肝功能，输血相关的铁过载也会如此。40%至50%的患者患有脂质代谢紊乱，这增加了心肌梗死、外周动脉闭塞性疾病和中风的风险。他们的预期寿命低于总体人群。
应采取措施预防异基因造血干细胞移植潜在的长期并发症。所有接受异基因造血干细胞移植治疗的患者都应接受个体化、风险适应性和多学科的随访护理，以便对出现的任何并发症能够正确诊断并进行适当治疗。通过前瞻性临床试验研究异基因造血干细胞移植的长期后遗症，以及在区域以上的数据登记处对这些后遗症进行一致、统一的记录，可改善长期随访护理。
