Department of Hematology, National Key Clinical Specialty of Hematology, Yunnan Blood Disease Clinical Medical Center, Yunnan Blood Disease Hospital, The First People's Hospital of Yunnan Province, Kunming, China.
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, Collaborative Innovation Center for Cancer Personalized Medicine, Nanjing, China.
Front Immunol. 2022 Jun 2;13:911174. doi: 10.3389/fimmu.2022.911174. eCollection 2022.
Poor graft function (PGF) is a life-threatening complication that occurs after transplantation and has a poor prognosis. With the rapid development of haploidentical hematopoietic stem cell transplantation, the pathogenesis of PGF has become an important issue. Studies of the pathogenesis of PGF have resulted in some success in CD34-selected stem cell boosting. Mesenchymal stem cells, N-acetyl-l-cysteine, and eltrombopag have also been investigated as therapeutic strategies for PGF. However, predicting and preventing PGF remains challenging. Here, we propose that the seed, soil, and insect theories of aplastic anemia also apply to PGF; CD34 cells are compared to seeds; the bone marrow microenvironment to soil; and virus infection, iron overload, and donor-specific anti-human leukocyte antigen antibodies to insects. From this perspective, we summarize the available information on the common risk factors of PGF, focusing on its potential mechanism. In addition, the safety and efficacy of new strategies for treating PGF are discussed to provide a foundation for preventing and treating this complex clinical problem.
移植物功能不良（PGF）是移植后发生的危及生命的并发症，预后不良。随着单倍体造血干细胞移植的快速发展，PGF 的发病机制已成为一个重要问题。PGF 发病机制的研究在 CD34 选择的干细胞增强方面取得了一些成功。间充质干细胞、N-乙酰-l-半胱氨酸和艾曲波帕也被研究作为 PGF 的治疗策略。然而，预测和预防 PGF 仍然具有挑战性。在这里，我们提出再生障碍性贫血的种子、土壤和昆虫理论也适用于 PGF；CD34 细胞比作种子；骨髓微环境比作土壤；病毒感染、铁过载和供体特异性抗人白细胞抗原抗体比作昆虫。从这个角度出发，我们总结了 PGF 常见危险因素的现有信息，重点讨论其潜在机制。此外，还讨论了治疗 PGF 的新策略的安全性和有效性，为预防和治疗这一复杂的临床问题提供了依据。
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