Sohn Sang Kyun, Moon Joon Ho
Dept. of Hematology, Kyungpook National University Hospital, 50 Samduck-2Ka, Jung-Ku, Daegu, South Korea.
Dept. of Hematology, Kyungpook National University Hospital, 50 Samduck-2Ka, Jung-Ku, Daegu, South Korea.
Crit Rev Oncol Hematol. 2015 Aug;95(2):243-50. doi: 10.1016/j.critrevonc.2015.03.004. Epub 2015 Mar 18.
According to current guidelines on therapeutic strategies for myelodysplastic syndrome (MDS), cytoreductive therapies before allogeneic stem cell transplantation (SCT) are not widely recommended for patients with high-risk MDS or refractory anemia with excess blasts (RAEB) who are eligible for allogeneic SCT because of controversial evidence on the role of such therapies. Yet, while treatment with hypomethylating agents (HMAs) has a critical limitation in eradicating MDS clones, the use of HMA treatment as a bridge to allogeneic SCT has become a focus with the hope of improving the SCT outcome based on the chance of achieving complete remission or reducing the blast percentage safely and effectively before allogeneic SCT. However, a consensus needs to be established on the use of HMAs as a bridging therapy for high-risk MDS or RAEB. Thus, the Korean AML/MDS working party group surveyed 34 Korean MDS experts on their bridging therapies for high-risk MDS. Accordingly, this paper presents the survey questionnaire and resulting data, along with a summary of the consensus and related recommendations regarding strategies using HMA treatment and allogeneic SCT based on reported studies and the current survey results.
根据目前关于骨髓增生异常综合征（MDS）治疗策略的指南，对于高危MDS或有过多原始细胞的难治性贫血（RAEB）且符合异基因干细胞移植（SCT）条件的患者，在异基因SCT前进行细胞减灭治疗未被广泛推荐，因为此类治疗作用的证据存在争议。然而，虽然使用去甲基化药物（HMA）治疗在根除MDS克隆方面存在关键局限性，但将HMA治疗用作异基因SCT的桥梁已成为一个焦点，人们希望基于在异基因SCT前实现完全缓解或安全有效地降低原始细胞百分比的机会来改善SCT结果。然而，对于将HMA用作高危MDS或RAEB的桥接治疗，需要达成共识。因此，韩国急性髓系白血病/骨髓增生异常综合征工作组对34位韩国MDS专家进行了关于高危MDS桥接治疗的调查。据此，本文展示了调查问卷及所得数据，以及基于已发表研究和当前调查结果的关于使用HMA治疗和异基因SCT策略的共识及相关建议的总结。
