Biology-Driven Approaches to Prevent and Treat Relapse of Myeloid Neoplasia after Allogeneic Hematopoietic Stem Cell Transplantation.
Biology-Driven Approaches to Prevent and Treat Relapse of Myeloid Neoplasia after Allogeneic Hematopoietic Stem Cell Transplantation.
复制标题
DOI：
10.1016/j.bbmt.2019.01.016
复制
发表时间：
2019-04
期刊：
影响因子：
--
通讯作者：
R. Zeiser;D. Beelen;W. Bethge;M. Bornhäuser;G. Bug;A. Burchert;M. Christopeit;J. Duyster;J. Finke;A. Gerbitz;J. Klusmann;G. Kobbe;M. Lübbert;C. Müller-Tidow;U. Platzbecker;W. Rösler;M. Sauer;C. Schmid;T. Schroeder;M. Stelljes;N. Kröger;L. Müller
中科院分区：
文献类型：
--
作者：
R. Zeiser;D. Beelen;W. Bethge;M. Bornhäuser;G. Bug;A. Burchert;M. Christopeit;J. Duyster;J. Finke;A. Gerbitz;J. Klusmann;G. Kobbe;M. Lübbert;C. Müller-Tidow;U. Platzbecker;W. Rösler;M. Sauer;C. Schmid;T. Schroeder;M. Stelljes;N. Kröger;L. Müller
异基因造血细胞移植(allo-HCT)治疗急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的疗效主要取决于移植物抗白血病效应。Allo-HCT后复发在相当大比例的患者中发生，预后很差，治疗潜力仍然非常有限。这篇综述在对复发生物学的新见解的背景下，对预防或治疗allo-HCT后AML和MDS复发的已建立和不断发展的方法进行了概述。已建立的预防措施以防止复发，包括优化调节和移植物抗宿主病(GVHD)预防，以及针对高危患者的供者淋巴细胞输注(DLI)；新的免疫调节干预和维持方法仍处于试验阶段。改进的诊断方法可以在分子水平上检测持续性或复发性疾病，从而能够及早进行先发制人的干预。已确定的选择包括去甲基化试剂和DLI。血液学复发的标准治疗包括化疗、停止免疫抑制治疗和DLI。实验方法包括分子靶向治疗、新的免疫调节治疗和第二次异基因红细胞移植。对于所有干预措施，包括发生移植物抗宿主病在内的潜在风险必须分别与每个患者的益处进行权衡。同时，预防和治疗allo-HCT后复发仍然是具有挑战性的和未得到满足的医疗需求。
The curative potential of allogeneic hematopoietic cell transplantation (allo-HCT) in the treatment of acute myelogenous leukemia (AML) and myelodysplastic syndrome (MDS) relies mainly on the graft-versus-leukemia effect. Relapse after allo-HCT occurs in a considerable proportion of patients and has a dismal prognosis, with still very limited curative potential. This review provides an overview of the established and evolving approaches to preventing or treating relapse of AML and MDS after allo-HCT, in the context of novel insight into the biology of relapse. Established prophylactic measures to prevent relapse include optimized conditioning and graft-versus-host disease (GVHD) prophylaxis, as well as donor lymphocyte infusion (DLI) for high-risk patients; novel immunomodulatory interventions and maintenance approaches are still experimental. Improved diagnostics can detect persistent or recurring disease at a molecular level, enabling early preemptive interventions. Established options include hypomethylating agents and DLI. Standard treatments for hematologic relapse include chemotherapy, cessation of immunosuppressive treatment, and DLI. Experimental approaches include molecular targeted therapies, novel immunomodulatory treatments, and second allo-HCT. For all interventions, the potential risks, including occurrence of GVHD, must be weighed against the benefits individually in each patient. Concurrently, prevention and treatment of relapse after allo-HCT remain challenging and unmet medical needs.