Li Chi-Cheng, Tsai Xavier Cheng-Hong, Huang Wei-Han, Wang Tso-Fu
Department of Hematology and Oncology, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Center of Stem Cell and Precision Medicine, Hualien Tzu Chi Hospital, Buddhist Tzu Chi Medical Foundation, Hualien, Taiwan.
Tzu Chi Med J. 2024 Mar 26;36(2):127-135. doi: 10.4103/tcmj.tcmj_276_23. eCollection 2024 Apr-Jun.
Hematopoietic stem cell transplantation (HSCT) can cure malignant and nonmalignant hematological disorders. From 1983 to 2022, Taiwan performed more than 10,000 HSCT transplants. The Taiwan Blood and Marrow Transplantation Registry collects clinical information to gather everyone's experience and promote the advances of HSCT in Taiwan to gather everyone's experience and promote advances of HSCT in Taiwan. Compared with matched sibling donors, transplants from matched unrelated donors exhibited a trend of superior survival. In Taiwan, transplant donors showed remarkable growth from unrelated (24.8%) and haploidentical (10.5%) donors. The number of older patients (17.4%; aged ≥61 years) who underwent transplantation has increased markedly. This review summarizes several significant developments in HSCT treatment in Taiwan. First, the use of Anti-thymocyte globulin (ATG) and intravenous busulfan regimens were important risk factors for predicting hepatic sinusoidal obstruction syndrome. Second, a new, machine learning-based risk prediction scoring system for posttransplantation lymphoproliferative disorder has identified five risk factors: aplastic anemia, partially mismatched related donors, fludarabine use, ATG use, and acute skin graft-versus-host disease. Third, although the incidence of idiopathic pneumonia syndrome was low (1.1%), its mortality rate was high (58.1%). Fourth, difficult-to-treat mantle cell and T-cell lymphomas treated with autologous HSCT during earlier remission had higher survival rates. Fifth, treatment of incurable multiple myeloma with autologous HSCT showed a median progression-free survival and overall survival of 46.5 and 70.4 months, respectively. Sixth, different haploidentical transplantation strategies were compared. Seventh, caution should be taken in administering allogeneic HSCT treatment in older patients with myeloid leukemia with a Charlson Comorbidity Index ≥3 because of a higher risk of nonrelapse mortality.
造血干细胞移植（HSCT）可治愈恶性和非恶性血液系统疾病。1983年至2022年，台湾进行了超过10000例HSCT移植。台湾血液和骨髓移植登记处收集临床信息，以汇集大家的经验并推动台湾HSCT的进展。与匹配的同胞供体相比，来自匹配的无关供体的移植显示出生存优势的趋势。在台湾，移植供体中来自无关供体（24.8%）和单倍体相合供体（10.5%）的数量显著增长。接受移植的老年患者（17.4%；年龄≥61岁）数量明显增加。本综述总结了台湾HSCT治疗的几项重大进展。首先，使用抗胸腺细胞球蛋白（ATG）和静脉白消安方案是预测肝窦阻塞综合征的重要危险因素。其次，一种基于机器学习的移植后淋巴增殖性疾病新风险预测评分系统确定了五个风险因素：再生障碍性贫血、部分不相合的相关供体、使用氟达拉滨、使用ATG以及急性皮肤移植物抗宿主病。第三，尽管特发性肺炎综合征的发病率较低（1.1%），但其死亡率较高（58.1%）。第四，早期缓解期接受自体HSCT治疗的难治性套细胞淋巴瘤和T细胞淋巴瘤生存率较高。第五，自体HSCT治疗不可治愈的多发性骨髓瘤的无进展生存期和总生存期的中位数分别为46.5个月和70.4个月。第六，比较了不同的单倍体相合移植策略。第七，对于Charlson合并症指数≥3的老年髓系白血病患者进行异基因HSCT治疗时应谨慎，因为非复发死亡率较高。
