Optimal stem cell source for allogeneic stem cell transplantation for hematological malignancies.
Optimal stem cell source for allogeneic stem cell transplantation for hematological malignancies.
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DOI：
10.5500/wjt.v3.i4.99
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发表时间：
2013-12-24
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影响因子：
--
通讯作者：
Cheuk, Daniel Kl
中科院分区：
文献类型：
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作者：
Cheuk, Daniel Kl
造血干细胞移植（HSCT）是许多血液系统恶性肿瘤的标准治疗方法。骨髓、外周血和脐带血三种不同来源的干细胞均可用于造血干细胞移植，各有其优缺点。随机对照试验（RCTs）表明，在成人恶性血液病患者的人类白细胞抗原匹配的同胞移植中，PBSC与BM相比没有显著的生存优势。PBSC移植可能导致较低的复发风险，因此更好的无病生存期，特别是在高风险疾病的患者中，代价是严重的急性和慢性移植物抗宿主病（GVHD）的风险更高。在无关供体环境中，唯一可用的RCT表明，PBSC和BM导致血液系统恶性肿瘤患者的总体和无病生存期相当; PBSC移植导致移植失败风险较低，慢性GVHD风险较高。与BM或PBSC相比，CB的高水平证据不可用。不同来源的干细胞的风险和益处可能会随着不同的预处理方案、GVHD的预防和治疗策略以及移植物的操作而变化。最近双CB移植和单倍相合BM和PBSC移植的成功和快速进展进一步使干细胞来源的选择复杂化。最佳选择需要仔细权衡不同干细胞来源对每个受体和供体的风险和益处。在患者和移植方法的特定背景下，对患者和供体进行详细的风险和益处咨询对于做出明智的决策至关重要。
Hematopoietic stem cell transplant (HSCT) is a standard treatment for many hematological malignancies. Three different sources of stem cells, namely bone marrow (BM), peripheral blood stem cells (PBSC) and cord blood (CB) can be used for HSCT, and each has its own advantages and disadvantages. Randomized controlled trials (RCTs) suggest that there is no significant survival advantage of PBSC over BM in Human Leukocyte Antigen-matched sibling transplant for adult patients with hematological malignancies. PBSC transplant probably results in lower risk of relapse and hence better disease-free survival, especially in patients with high risk disease at the expense of higher risks of both severe acute and chronic graft-versus-host disease (GVHD). In the unrelated donor setting, the only RCT available suggests that PBSC and BM result in comparable overall and disease-free survivals in patients with hematological malignancies; and PBSC transplant results in lower risk of graft failure and higher risk of chronic GVHD. High level evidence is not available for CB in comparison to BM or PBSC. The risks and benefits of different sources of stem cells likely change with different conditioning regimen, strategies for prophylaxis and treatment of GVHD and manipulation of grafts. The recent success and rapid advance of double CB transplant and haploidentical BM and PBSC transplants further complicate the selection of stem cell source. Optimal selection requires careful weighing of the risks and benefits of different stem cell source for each individual recipient and donor. Detailed counseling of patient and donor regarding risks and benefits in the specific context of the patient and transplant method is essential for informed decision making.