Hematopoietic Cell Transplantation for Older Patients with MDS.
Hematopoietic Cell Transplantation for Older Patients with MDS.
复制标题
DOI：
10.4084/mjhid.2014.056
复制
发表时间：
2014
影响因子：
3.2
通讯作者：
Deeg HJ
中科院分区：
文献类型：
--
作者：
Shadman M;Deeg HJ
骨髓恶性肿瘤，包括骨髓增生异常综合征（MDS）的发病率随年龄增加。虽然已经开发了几种治疗方式，但对于大多数这些患者来说，唯一具有治愈潜力的治疗方法是异基因造血细胞移植（HCT）。降低/低强度移植预处理方案的发展允许60多岁甚至70多岁的患者成功移植，尽管合并症可能决定谁来移植，谁不来移植。此外，多达一半的患者将发展移植物抗宿主病（GVHD），即使是HLA匹配的供体，也需要长时间的治疗，并且GVHD和糖皮质激素治疗可能影响生活质量。然而，根据HCT时的疾病分期、合并症的存在和使用的治疗方案，30%至50%的60岁或以上的患者可以长期治愈他们的疾病。未来的研究应侧重于将非移植方式纳入整体移植方法，预防GVHD，并利用免疫治疗来降低复发和GVHD的发生率，进一步提高整体移植成功率。
The incidence of myeloid malignancies, including myelodysplastic syndromes (MDS) increases with age. While several therapeutic modalities have been developed, for most of these patients the only treatment with curative potential is allogeneic hematopoietic cell transplantation (HCT). The development of reduced/low intensity transplant conditioning regimens allows to successfully transplant patients in their ‘60s and even ‘70s, although comorbidities may determine who does come to transplantation and who does not. Also, as many as half of the patients will develop graft versus host disease (GVHD), even with HLA matched donors, requiring therapy for extended periods of time, and GVHD and treatment with glucocorticoids is likely to impact the quality of life. Nevertheless, dependent upon disease stage at HCT, the presence of comorbidities and the regimen used, 30% to 50% of patients 60 years of age or older, may survive long-term cured of their disease. Future studies should focus on the incorporation of non-transplant modalities into the overall transplant approach, the prevention of GVHD, and the utilization of immunotherapy to reduce the incidence of relapse and GVHD and further improve overall transplant success.