造血干细胞移植治疗骨髓增生异常综合征研究新动向

New Progress of Study on Hematopoietic Stem Cell Transplantation for Myelodysplastic Syndromes——Review

造血干细胞移植(HSCT)是唯一有可能治愈MDS的疗法,目前有多种评分系统用于MDS患者的评估,包括国际预后积分系统、WHO预后评分系统、简化MDS评分系统等,不仅可预测接受干细胞移植MDS患者的成功率,还有助于移植时机的选择。对于高龄及伴有严重并发症的患者,采用合理的预处理方案可降低治疗相关死亡率。通过对患者并发症的管理、选择个体化的预处理方案、移植时机及适当的供者,将提高HSCT治疗MDS的疗效。如何减少移植后复发及GVHD的发生仍需进一步努力。本文就MDS的评分系统、影响HSCT效果的因素、HSCT的供者和时机的选择、HSCT前预处理强度及HSCT效果的评价进行了综述。

Hematopoietic stem cell transplantation（HSCT） is the only way to cure myelodysplastic syndromes.At present there are several myelodysplastic syndromes scoring systems,including the International Prognostic Scoring System（IPSS）,WHO Prognostic Scoring System（WPSS） and Simplified MDS Risk Score.These score systems can not only predict the probability of transplant success,but also help to detemine the time of transplatation.For the older patient with serious complication,a suitable conditioning regimen can lower the risk of treatment-related mortality.Complication management,individualized conditioning regimen,optimal timing of transplantation and donor selection should improve the curative effect of HSCT.However,post-transplatation relapse and graft-versus-host disease（GVHD） remain to be selved and further investigations are needed.In this review the MDS scoring syotem,factors influencing HSCT efficacy,the selection of HSCT denors and timing,the preconditioning intensity before HSCT and evaluation of HSCT efficacy are summarized.