Second EBMT Workshop on reduced intensity allogeneic hemopoietic stem cell transplants (RI-HSCT)
Second EBMT Workshop on reduced intensity allogeneic hemopoietic stem cell transplants (RI-HSCT)
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DOI：
10.1038/sj.bmt.1703355
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发表时间：
2002-02-01
影响因子：
4.8
通讯作者：
Bacigalupo, A
中科院分区：
文献类型：
--
作者：
Bacigalupo, A
2001年2月在苏黎世召开了第二次关于降低强度异基因干细胞移植（RI-HSCT）的会议，重点讨论了移植相关死亡率（TRM）和移植物抗宿主病（GVHD）。来自EBMT、国家组和单个机构的回顾性和前瞻性研究包括900多名患者：急性GVHD III-IV级的发生率为12%（1-17%），广泛慢性GVHD 42%（25-51%）和TRM 20%（14-38%）。预处理方案可根据（1）全身照射（TBI）200 cGy、（2）白消安8 mg/kg、（3）噻替派10 mg/kg和（4）美法仑140 mg/ml分为四个主要组：这些方案中的大多数与不同剂量的氟达拉滨联合给药，并使用动员的外周血作为干细胞来源。TRM的发生率是相似的，如果不是完全相同的所有四个方案，而急性GVHD和慢性GVHD的风险可能会有所不同的协议。在60岁以上的患者和实体瘤患者中正在探索降低强度的移植计划：在个体患者中记录了令人鼓舞的结果。总体而言，这些数据证实，同种异体HSCT可以在老年患者中进行，尽管TRM必须约为15%，并且与年龄有关。广泛的慢性GVHD发生率很高，应仔细随访。术语小型或微型移植可能会引起误解，应该将此程序称为同种异体HSCT，并进一步分类预处理方案的强度。
A second meeting on reduced intensity allogeneic stem cell transplants (RI-HSCT) was convened in Zurich in February 2001 and focused on transplant-related mortality (TRM) and graft-versus-host disease (GVHD). Retrospective and prospective studies from the EBMT, national groups and single institutions included over 900 patients: the incidence of acute GVHD grade III-IV was 12% (1-17%), extensive chronic GVHD 42% (25-51%) and TRM 20% (14-38%). Conditioning regimens could be classified into four major groups based on (1) total body irradiation (TBI) 200 cGy, (2) busulfan 8 mg/kg, (3) thiotepa 10 mg/kg, and (4) melphalan 140 mg/ml: most of these regimens are given in association with fludarabine in different doses and use mobilized peripheral blood as a source of stem cells. The incidence of TRM is similar if not identical for all four regimens, whereas the risk of acute GVHD and chronic GVHD may vary with different protocols. Reduced intensity transplant programs are being explored in patients above the age of 60 and in patients with solid tumors: encouraging results are being recorded in individual patients. Overall these data confirm that allogeneic HSCT can be performed in elderly patients, although a TRM of approximately 15% must be expected and is age dependent. A high rate of extensive chronic GVHD is seen and should be followed carefully. The term mini-or micro-transplant is probably misleading and one should refer to this procedure as an allogeneic HSCT and further classify the intensity of the conditioning regimen.