Alby N, Bernard A, Devergie A, Goldman J M, Hervé P, Maraninchi P, Raffoux C, Gluckman E
Unité Fonctionnelle de Greffe de Moelle Osseuse, Hôpital Saint-Louis, France.
Nouv Rev Fr Hematol (1978). 1988;30(1-2):55-64.
The complexity of host-graft interactions after bone marrow transplantation explains the criteria of choice of the donor. Graft rejection, graft-versus-host disease, graft-versus-leukemia, delayed immune reconstitution, often associated or mutually exclusive are observed even with an HLA identical sibling donor. Syngeneic transplants may be complicated by leukemic relapse related to the loss of the graft-versus-leukemia effect. The compilation of files of unrelated donors increases the possibility of finding a matched unrelated donor. Preliminary results suggest that clinical results may be equivalent to those achieved with HLA identical sibling donors. Overall results of HLA mismatched transplants are disappointing because of the increase of immunological complications. Attempts at preventing graft-versus-host disease with T cell depletion led to an increase of immunological complications: rejection and leukemic relapse. Modifications of the conditioning regimen and use of in vivo monoclonal antibodies are currently being investigated. Ethical, legal, and psychological considerations have also to be taken into account in the donor choice especially with the increase of the donor pool.
骨髓移植后宿主与移植物相互作用的复杂性解释了供体选择的标准。即使是与受者HLA配型相同的同胞供体，也会出现移植物排斥、移植物抗宿主病、移植物抗白血病效应、免疫重建延迟等情况，这些情况常常相互关联或相互排斥。同基因移植可能因移植物抗白血病效应的丧失而并发白血病复发。无关供体档案的汇编增加了找到匹配的无关供体的可能性。初步结果表明，临床结果可能与HLA配型相同的同胞供体移植的结果相当。由于免疫并发症的增加，HLA配型不相合移植的总体结果令人失望。尝试通过去除T细胞来预防移植物抗宿主病导致免疫并发症增加：排斥反应和白血病复发。目前正在研究调整预处理方案和使用体内单克隆抗体。在选择供体时，尤其是随着供体库的扩大，伦理、法律和心理因素也必须考虑在内。
