Acute graft-versus-host disease: differing risk with differing graft sources and conditioning intensity
Acute graft-versus-host disease: differing risk with differing graft sources and conditioning intensity
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DOI：
10.1016/j.beha.2008.02.006
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发表时间：
2008-06-01
影响因子：
2.1
通讯作者：
Johnston, Laura
中科院分区：
文献类型：
--
作者：
Johnston, Laura
急性移植物抗宿主病(AGVHD)是异基因造血细胞移植(HCT)的一个恒定组成部分，其发病率和严重程度受移植物来源、人类白细胞抗原(HLA)相容和制备方案的影响。本文讨论了移植物来源相关供者与非亲缘供者、骨髓(BM)与外周血(PB)、脐血(UCB)与非亲缘供者BM之间的关系，以及清髓与降低强度(RI)制备方案。最近对匹配的亲属供者和匹配的非亲缘供者的红细胞压积的比较支持这两个供者之间在aGVHD方面的微小差异。在随机和II期临床对比试验中，比较了骨髓和动员外周血在匹配亲属供者(MRD)环境中的使用情况，这些临床试验支持成人人群中aGVHD略有增加。在无血缘关系捐献者(URD)环境中也看到了类似的结果，尽管到目前为止只有最少的比较数据。UCB和URD BM的初步比较显示，尽管增加了HLA不匹配，但UCB的aGVHD发生率较低。由于免疫重建延迟和疾病复发，单倍体相合的HCT仍在继续探索。已经发表了许多降低强度的准备方案，与历史上的清髓性准备方案相比，aGVHD的发生率减少或差异很小。需要对不同的移植物来源以及准备方案的强度进行更正式的比较，以更准确地确定这些移植方案之间的差异。
Acute graft-versus-host disease (aGVHD) is a constant component of allogeneic hematopoietic cell transplantation (HCT), with variations in incidence and severity affected by the graft source, human leukocyte antigen (HLA) compatibility, and the preparative regimen. The graft source related versus unrelated donors, bone marrow (BM) versus peripheral blood (PB), umbilical cord blood (UCB) versus unrelated donor BM - are discussed in this review, as well as myeloablative versus reduced-intensity (RI) preparative regimens. Recent comparisons of matched related versus matched unrelated donor HCT support a minimal difference in aGVHD between these two donor sources. The use of BM versus mobilized PB in the matched related donor (MRD) setting has been compared in randomized as well as phase-II comparative clinical trials which support a slight increase in aGVHD in the adult population. Similar results have been seen in the unrelated donor (URD) setting, although based on minimal comparative data to date. Preliminary comparisons of UCB versus URD BM have shown a decreased incidence of aGVHD with UCB, despite increased HLA mismatching. Haploidentical HCT has continued to be explored, with limitations due to delayed immune reconstitution and disease relapse. Many reduced-intensity preparative regimens have been published, with a reduced or minimal difference in incidence of aGVHD when historically compared to myleoablative preparative regimens. More formal comparisons of the different graft sources as well as preparative regimen intensities will be required to determine a more accurate picture of the differences between these transplantation alternatives.