Allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia: myths, controversies, and unknowns
Allogeneic hematopoietic cell transplantation for adults with acute myeloid leukemia: myths, controversies, and unknowns
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DOI：
10.1182/blood-2010-10-265603
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发表时间：
2011-02-24
期刊：
影响因子：
20.3
通讯作者：
Weisdorf, Daniel J.
中科院分区：
文献类型：
--
作者：
Gupta, Vikas;Tallman, Martin S.;Weisdorf, Daniel J.
过去十年的进展提高了对白血病生物学的理解。分子标记结合细胞遗传学改善了急性髓性白血病（AML）的风险分层和知情决策。与此同时，移植领域的几项重要进展，如更好的支持性护理、移植技术的改进、替代供体的可用性的增加和强度调节的降低，提高了异体造血细胞移植（HCT）的安全性，并为更多患者提供了获取途径。在这篇综述中，从与常规治疗和移植相关的风险/收益比的变化来看，评估了HCT在AML患者管理中的定位，并根据新出现的数据解决了一些争议。越来越多的数据表明，在高风险AML中，接近hla相同的兄弟姐妹供体的替代供体移植的结果支持在评估高风险AML缓解后策略的前瞻性研究中纳入替代供体。低强度调节的使用将HCT的适用范围扩大到老年AML患者，结果数据令人鼓舞。需要继续研究HCT与替代疗法，以优化AML患者的预后。(血。2011;117 (8):2307 - 2318)
Progress in the last decade has improved the understanding of leukemia biology. Molecular markers in combinations with cytogenetics have improved the risk stratification of acute myeloid leukemia (AML) and informed decision-making. In parallel, several important advances in the transplant field, such as better supportive care, improved transplant technology, increased availability of alternative donors, and reduced-intensity conditioning have improved the safety as well as access of allogeneic hematopoietic cell transplantation (HCT) for a larger number of patients. In this review, the positioning of HCT in the management of patients with AML is evaluated in view of changing risk/benefit ratios associated with both conventional treatments and transplantation, and some of the controversies are addressed in light of emerging data. Increasing data demonstrate outcomes of alternative donor transplantation approaching HLA-identical sibling donors in high-risk AML supporting the inclusion of alternative donors in trials of prospective studies evaluating post remission strategies for high-risk AML. The use of reduced-intensity conditioning has expanded the eligibility of HCT to older patients with AML, and outcome data are encouraging. Continued study of HCT versus alternative therapies is required to optimize patients' outcomes in AML. (Blood. 2011;117(8):2307-2318)