Hematopoietic stem cell transplantation-50 years of evolution and future perspectives.
Hematopoietic stem cell transplantation-50 years of evolution and future perspectives.
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DOI：
10.5041/rmmj.10162
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发表时间：
2014-10
影响因子：
1.5
通讯作者：
Zuckerman T
中科院分区：
文献类型：
--
作者：
Henig I;Zuckerman T
造血干细胞移植是一种高度专业化和独一无二的医学程序。自体移植可以在不延长骨髓再生障碍性疾病的情况下进行大剂量化疗。在异基因移植中，供者来源的干细胞提供同种免疫，使移植物抗肿瘤效应能够根除残留疾病和防止复发。第一例同种异体移植是由E·唐纳尔·托马斯于1957年进行的。从那时起，这一领域在世界范围内不断发展和扩大。除了急性白血病和再生障碍性贫血之外，新的适应症也在不断探索，现在包括先天性造血系统障碍、代谢障碍和自身免疫性疾病。匹配的非亲缘供者、脐带血和部分匹配的亲缘供者的使用极大地扩大了同种异体移植的可获得性。由于改善了支持性护理，包括更好的预防严重感染的战略，以及纳入了降低毒性并允许老年患者进行移植的降低强度的条件调节方案，移植相关死亡率有所下降。然而，疾病复发和移植物抗宿主病仍然是导致死亡的两大原因，但进展并不令人满意。密集的研究旨在改善过继免疫治疗，提高移植物抗白血病反应，同时降低移植物抗宿主反应，这可能会带来异基因移植的下一个突破。移植物操作、肿瘤相关抗原疫苗接种、单抗和过继细胞免疫治疗的策略已被证明在临床上有效。在接下来的几年里，同种异体移植可能会变得更加复杂、更加个性化和更加有效。
Hematopoietic stem cell transplantation is a highly specialized and unique medical procedure. Autologous transplantation allows the administration of high-dose chemotherapy without prolonged bone marrow aplasia. In allogeneic transplantation, donor-derived stem cells provide alloimmunity that enables a graft-versus-tumor effect to eradicate residual disease and prevent relapse. The first allogeneic transplantation was performed by E. Donnall Thomas in 1957. Since then the field has evolved and expanded worldwide. New indications beside acute leukemia and aplastic anemia have been constantly explored and now include congenital disorders of the hematopoietic system, metabolic disorders, and autoimmune disease. The use of matched unrelated donors, umbilical cord blood units, and partially matched related donors has dramatically extended the availability of allogeneic transplantation. Transplant-related mortality has decreased due to improved supportive care, including better strategies to prevent severe infections and with the incorporation of reduced-intensity conditioning protocols that lowered the toxicity and allowed for transplantation in older patients. However, disease relapse and graft-versus-host disease remain the two major causes of mortality with unsatisfactory progress. Intense research aiming to improve adoptive immunotherapy and increase graft-versus-leukemia response while decreasing graft-versus-host response might bring the next breakthrough in allogeneic transplantation. Strategies of graft manipulation, tumor-associated antigen vaccinations, monoclonal antibodies, and adoptive cellular immunotherapy have already proved clinically efficient. In the following years, allogeneic transplantation is likely to become more complex, more individualized, and more efficient.