Long-Term Consequences of Hematopoietic Stem Cell Transplantation: Current State of the Science
Long-Term Consequences of Hematopoietic Stem Cell Transplantation: Current State of the Science
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DOI：
10.1016/j.bbmt.2009.09.017
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发表时间：
2010-01-01
影响因子：
4.3
通讯作者：
Bhatia, Smita
中科院分区：
文献类型：
--
作者：
Baker, K. Scott;Armenian, Saro;Bhatia, Smita
造血细胞移植（HCT）是一种治疗多种血液恶性肿瘤的既定选择。移植适应症的自由化加上造血干细胞（HSC）来源选择的增加是每年进行HCT数量增加的原因[1]。移植技术和支持性护理策略的进步已导致生存率的显著改善，因此长期生存现已成为接受HCT的患者的预期结局。然而，在移植前以及移植时暴露于化疗，加上长期的免疫抑制和疾病复发的风险，使这一人群患慢性健康状况的风险增加，如心脏损害、内分泌后遗症和随后的恶性肿瘤。此外，过早死亡仍然是卫生保健提供者以及成功度过HCT后即刻期的患者的重大关切。以下章节将重点关注接受HCT的患者的长期生存率和过早死亡的原因;长期生存者遭受的总体发病负担，特别强调代谢综合征在该人群中的发生及其对心功能不全的影响，以及了解HCT后并发症风险的个体差异的必要性，因为我们更接近个性化医疗。
Hematopoietic cell transplantation (HCT) is an established curative option for a variety of hematologic malignancies. Liberalization in the indications for transplantation coupled with an increase in options in the source of the hematopoietic stem cells (HSCs) are responsible for the increasing number of HCTs performed annually [1]. Advances in transplantation techniques and supportive care strategies have resulted in a significant improvement in survival, such that long-term survival has now become an expected outcome for patients undergoing HCT. However, exposure to chemotherapy prior to transplantation as well as at the time of transplantation, coupled with prolonged periods of immune suppression and the risk of disease recurrence, place this population at an increased risk of chronic health conditions, such as cardiac compromise, endocrine sequelae, and subsequent malignancies. Furthermore, premature death remains of significant concern among health care providers as well as patients who have successfully survived the immediate post-HCT period. The following sections will focus on long-term survival and causes of premature death among patients undergoing HCT; on the overall burden of morbidity suffered by longterm survivors, with special emphasis on the occurrence of metabolic syndrome in this population and its impact on cardiac dysfunction and the need to understand individual variability in the risk for post-HCT complications, as we move closer to personalized medicine.