现代造血细胞移植幸存者护理中的挑战与机遇

Challenges and Opportunities in the Care of Hematopoietic Cell Transplant Survivors in the Modern Era.

作者信息

Bhatt Neel S, Richards Alexis, Beebe Kristen L, Khera Nandita

机构信息

Fred Hutchinson Cancer Center, Seattle, WA, USA.

University of Washington, Seattle, WA, USA.

出版信息

Adv Exp Med Biol. 2025;1475:209-226. doi: 10.1007/978-3-031-84988-6_12.

Abstract

With the constantly changing field of hematopoietic cell transplant (HCT) and cellular therapy and a growing number of survivors, there is an ongoing need for work to understand the changing landscape of late effects and develop interventions to optimize the long-term outcomes of survivors. In this chapter, we summarize the studies published in last 5 years describing late effects after HCT. We specifically discuss the available literature or the lack thereof for the late effects as it relates to the changes in transplant practices such as increased use of post-transplant cyclophosphamide, newer drugs to treat chronic graft vs. host disease, and chimeric antigen receptor T-cell therapy as a bridge to HCT or for a post-HCT relapse. We also summarize the recently updated recommendations for screening and management of late effects and a monitoring plan to cater to late effects specific to patients undergoing transplants for non-malignant diseases. We discuss the specific considerations such as challenges for adolescent and young adult HCT survivors, especially as they transition from pediatric to adult care. With the information discussed here, we outline challenges and opportunities for research and clinical practice highlighting the role of health care delivery models in addressing some of these issues.

摘要

随着造血细胞移植(HCT)和细胞治疗领域的不断变化以及幸存者数量的增加,持续需要开展工作来了解迟发效应不断变化的情况,并制定干预措施以优化幸存者的长期结局。在本章中,我们总结了过去5年发表的描述HCT后迟发效应的研究。我们特别讨论了与移植实践变化相关的迟发效应的现有文献或文献缺失情况,这些变化包括移植后环磷酰胺使用增加、治疗慢性移植物抗宿主病的新药以及嵌合抗原受体T细胞疗法作为HCT的桥梁或用于HCT后复发。我们还总结了最近更新的迟发效应筛查和管理建议以及针对非恶性疾病移植患者特定迟发效应的监测计划。我们讨论了一些具体考虑因素,例如青少年和年轻成人HCT幸存者面临的挑战,尤其是在他们从儿科护理过渡到成人护理时。基于此处讨论的信息,我们概述了研究和临床实践面临的挑战与机遇,强调了医疗服务提供模式在解决其中一些问题方面的作用。

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