自体造血干细胞移植治疗急性白血病:历史传承、体系建设与优化

Treatment of Autologous Hematopoietic Stem Cell Transplantation for Acute Leukemia:Historical Inheritance,System Construction and Optimization

自体造血干细胞移植(autologous hematopoietic stem cell transplantation,ASCT)是急性白血病(acute leukemia,AL)缓解后治疗的重要方法,尤其是对首次完全缓解(first complete remission,CR1)的低危、中危急性髓系白血病(acute myeloid leukemia,AML),复发后再次完全缓解(CR2)的急性早幼粒白血病(acute promyelocytic leukemia,APL)及费城染色体阳性急性淋巴细胞白血病(Philadelphia chromosome-positive acute lymphoblastic leukemia,Ph;ALL)的患者而言,ASCT具有良好的临床疗效。微小残留疾病(minimal residual disease,MRD)状态、预处理方案、移植后维持治疗等因素与ASCT后的疾病预后密切相关。中国医学科学院血液病医院实施了中国第一例ASCT,并结合基础与临床研究逐渐形成和不断完善了ASCT治疗AL的诊疗体系,取得了良好的临床疗效。该文从造血干细胞(hematopoietic stem cells,HSCs)维持与再生的机制和调控因素等ASCT基础理论、ASCT治疗AL适应症及疗效等方面对ASCT治疗AL的历史传承及诊疗体系的建设与优化进行综述,以期促进ASCT治疗AL的诊疗策略完善与发展,从而进一步改善AL患者的预后。

ASCT(autologous hematopoietic stem cell transplantation)is one of important post-remission treatments for AL(acute leukemia),especially in patients with low or moderate risk AML(acute myeloid leukemia)with CR1(first complete remission),APL(acute promyelocytic leukemia)with CR2(relapse and complete remission)or Ph;ALL(Philadelphia chromosome-positive acute lymphoblastic leukemia).Meanwhile,MRD(minimal residual disease)status,conditioning regimens,maintenance treatment after transplantation and other factors are closely related to the prognosis of the diseases after ASCT.This article reviews the mechanisms and regulatory factors of the maintenance and self-renewal of HSCs(hemetopoietic stem cells).Besides,the research shares the diagnosis and treatment system and evaluation methods of ASCT established by the Institute of Hematology of the Chinese Academy of Medical Sciences and the Hematological Disease Hospital in order to promote the development and standardization of diagnosis and treatment strategies of ASCT in the treatment of AL,so as to improve the prognosis of patients with AL to the greatest extent.