重型再生障碍性贫血患者异基因造血干细胞移植后混合嵌合的研究现状

Research status of mixed chimerism after allogeneic hematopoietic stem cell transplantation in patients with severe aplastic anemia

随着人类白细胞抗原(HLA)配型技术的提高,供者选择的多样化及支持治疗的不断发展,异基因造血干细胞移植(allo-HSCT)成为重型再生障碍性贫血(SAA)患者的重要治疗手段。目前,越来越多SAA患者有条件接受allo-HSCT,但是allo-HSCT后混合嵌合(MC)发生率较高,可导致继发性植入失败(SGF),显著影响患者的疗效和预后。免疫抑制治疗(IST)和供者淋巴细胞输注(DLI)等细胞治疗是纠正MC的主要干预措施,但同时具有诱发移植物抗宿主病(GVHD)风险。因此,通过监测供者嵌合(DC)状态指导干预决策和选择最佳干预时机具有重要临床意义。笔者拟就MC概述、MC对SAA患者接受allo-HSCT疗效和预后的影响、SAA患者接受allo-HSCT后发生MC的危险因素和临床干预等方面的研究现状进行阐述。

Allogeneic hematopoietic stem cell transplantation(allo-HSCT)has become a chief treatment for severe aplastic anemia(SAA)patients with the improvement of human leucocyte antigen(HLA)matching technology,the diversification of donor selection,and rapid progression of supportive therapy.Currently,more and more SAA patients are qualified to receive allo-HSCT,but the incidence of mixed chimerism(MC)after allo-HSCT is high,which can lead to secondary implantation failure(SGF)and significantly affect the patients′efficacy and prognosis.Immunosuppressive therapy(IST)and cell therapy such as donor lymphocyte infusion(DLI)are main interventions to correct MC.However,those patients also have the risk of inducing graft versus host disease(GVHD).Therefore,monitoring of donor chimerism(DC)status can guide clinical judgment of the optimal intervention and selection of best intervention timing is particularly important for patients with SAA.This article intends to elaborate on current research status of the overview of MC,the impact of MC on the efficacy and prognosis of SAA patients,as well as the risk factors and clinical interventions for MC in SAA patients after allo-HSCT.