Overcoming relapse: prophylactic or pre-emptive use of azacitidine or FLT3 inhibitors after allogeneic transplantation for AML or MDS
Overcoming relapse: prophylactic or pre-emptive use of azacitidine or FLT3 inhibitors after allogeneic transplantation for AML or MDS
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DOI：
10.1007/s12185-023-03596-w
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发表时间：
2023-04-10
影响因子：
2.1
通讯作者：
Najima，Yuho
中科院分区：
文献类型：
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作者：
Najima，Yuho
复发是异基因造血干细胞移植（HSCT）治疗的最大障碍。非复发死亡率每年都有所改善，但复发死亡率仍然很高。移植后维持治疗，如低甲基化剂和FMS样酪氨酸激酶3（FLT 3）抑制剂，已被研究了几十年，作为预防HSCT后疾病复发的一种手段。除了原发疾病的复发趋势外，其他可能影响接受HSCT患者估计疾病负担转变的因素包括HSCT时的疾病状态（未缓解、缓解伴微小/可测量残留病变（MRD）和缓解不伴MRD）和预处理方案强度。最佳选择复发风险高且能耐受长时间治疗的患者是成功进行移植后维持治疗的关键。本文综述了近年来使用阿扎胞苷或FLT 3抑制剂预防AML或MDS患者HSCT后疾病复发的移植后维持治疗研究进展，并对该领域的发展前景进行了展望。
Relapse remains the most critical obstacle in treatment by allogeneic hematopoietic stem cell transplantation (HSCT). Non-relapse mortality has improved annually, but relapse mortality remains high. Post-transplant maintenance treatment, such as hypomethylating agents and FMS-like tyrosine kinase 3 (FLT3) inhibitors, has been investigated for decades as a means of preventing disease relapse after HSCT. Other factors besides the relapse tendency of the primary disease that can affect the transition of estimated disease burden in patients undergoing HSCT are disease status at HSCT (non-remission, remission with minimal/measurable residual disease (MRD), and remission without MRD) and conditioning regimen intensity. Optimal selection of patients at high risk for relapse who can tolerate a long duration of therapy is pivotal for successful post-transplant maintenance therapy. In this review, we provide an overview of current progress in research on post-transplant maintenance treatment using azacitidine or FLT3 inhibitors for preventing disease relapse after HSCT for AML or MDS, and discuss the future outlook in this area.