低强度预处理异基因造血干细胞移植治疗骨髓增生异常综合征研究进展

Progress of Research on Allogeneic Hematopoietic Stem Cell Transplantation with Reduced-intensity Conditioning Regimen for Treatment of Myelodysplastic Syndrome——Review

异基因造血干细胞移植(allo-HSCT)是治疗骨髓增生异常综合征(MDS)的有效手段,MDS发病率随年龄增加而增加,尽管近年来传统清髓性移植治疗MDS取得可喜的成绩,但对于年龄大于60岁的MDS患者,allo-HSCT预后差,低强度预处理异基因造血干细胞移植(RIC allo-HSCT)使老年MDS患者进行allo-HSCT成为可能,利用供者淋巴细胞的移植物抗肿瘤作用显著降低移植相关器官毒性及非复发死亡率。本文就RIC-HSCT治疗MDS的问题诸如RIC allo-HSCT治疗MDS可行性,MDS病例选择,RIC allo-HSCT的时机干细胞来源,RIC预处理方案,疗效及预后评价,GVHD与移植物抗MDS效应等的研究进展做一综述及展望。

Allogeneic haematopoietic stem cell transplantation （allo-HCT） is the most effective curative therapy in myelodysplastic syndromes （MDS）. Incidence of MDS increases with age, peaking in the seventh decade of last century. Despite improved consolidation chemotherapy regimens, the prognosis of MDS in patients beyond 60 years of age is dismal. The introduction of peripheral blood-derived stem cell grafts into allogeneic HSCT and the known antitumor effect of donor lymphocyte infusions paved the way for reduced-intensity conditioning （RIC） allogeneic hematopoietic stem-cell transplantation, which makes transplant possible in advanced age, significantly alleviates transplant-related organ toxicity and decreases non-relapse mortality. This article reviews the advanced development of reduced-intensity conditioning regimens in allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes and the future of reduced intensity conditioning hematopoietic stem cell transplants including feasiblity of RIC allo-HSCT in treating patients with MDS, selection of MDS cases for RIC allo-HSCT, opportunity of RIC allo-HSCT, source of stem cells for RIC allo-HSCT, RIC regimen for allo-HSCT, evalnation of curative efficacy and prognosis, GVHD and graft versus MDS, and so on.