Comorbidities and Hematopoietic Cell Transplantation Outcomes
Comorbidities and Hematopoietic Cell Transplantation Outcomes
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DOI：
10.1182/asheducation-2010.1.237
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发表时间：
2010-12-01
影响因子：
3
通讯作者：
Sorror, Mohamed L.
中科院分区：
文献类型：
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作者：
Sorror, Mohamed L.
传统的异基因造血细胞移植(allo-HCT)是一种潜在的治疗各种血液病的选择，部分是由于高剂量的条件作用，部分是由于移植物抗肿瘤的效果。低强度或非清髓性的预适应方案主要依靠移植物抗肿瘤效应来控制疾病，它们的出现使相对年长和身体虚弱的患者能够接受异基因红细胞移植。然而，这两种HCT模式都与器官毒性和移植物抗宿主病有关，导致大量无复发死亡。为了改进HCT决策和临床试验分配，优化移植前风险评估已变得越来越重要。传统上认为，HCT前累及肝脏、肺、心脏或肾脏的单个器官共病会导致HCT后的器官毒性。最近的努力导致了加权评分系统的出现，该系统可以在HCT之前灵敏地捕捉到多器官并存。与其他非HCT特异性指数相比，HCT-CI指数能更好地预测与HCT相关的发病率和死亡率。随后的研究，除了少数患者数量不多的研究外，都证实了HCT-CI对预后的重要性。此外，HCT-CI已与各种疾病特定的风险因素和患者特定的风险因素进行了整合，以完善患者对适当的HCT环境的分配。正在进行的研究涉及对HCT-CI的前瞻性验证，进一步加深我们对生物衰老的理解，并增强HCT-CI共病编码的适用性。未来对多种并发症对HCT后毒性影响的了解可能会指导新的预防和治疗干预措施，以降低该手术的死亡率。
Conventional allogeneic hematopoietic cell transplantation (allo-HCT) is a potentially curative treatment option for various hematological diseases due, in part to high-dose conditioning and, in part, to graft-versus-tumor effects. Reduced-intensity or non-myeloablative conditioning regimens have relied mostly on graft-versus-tumor effects for disease control, and their advent has allowed relatively older and medically infirm patients to be offered allo-HCT. However, both HCT modalities have been associated with organ toxicities and graft-versus-host disease, resulting in substantial non-relapse mortality. It has become increasingly important to optimize pre-transplant risk assessment in order to improve HCT decision making and clinical trial assignments. Single-organ comorbidity involving liver, lung, heart, or kidney before HCT has been traditionally found to cause organ toxicity after HCT. Recent efforts have resulted in the advent of a weighted scoring system that could sensitively capture multiple-organ comorbidities prior to HCT. The HCT-comorbidity index (HCT-CI) has provided better prediction of HCT-related morbidity and mortality than other non-HCT-specific indices. Subsequent studies, with the exception of a few studies with modest numbers of patients, have confirmed the prognostic importance of the HCT-CI. Further, the HCT-CI has been consolidated with various disease-specific and patient-specific risk factors to refine assignments of patients to the appropriate HCT setting. Ongoing studies are addressing prospective validation of the HCT-CI, furthering our understanding of biological aging, and enhancing the applicability of the HCT-CI comorbidity coding. Future knowledge of the impacts of multiple comorbidities on post-HCT toxicities might guide new prophylactic and therapeutic interventions to lessen the procedure's mortality.