Allogeneic hematopoietic stem cell transplant(HSCT) remains the only potentially curative option for variety of hematologic disorders. Lack of a suitable fully HLAmatched donor limits this option for many patients. Wi...Allogeneic hematopoietic stem cell transplant(HSCT) remains the only potentially curative option for variety of hematologic disorders. Lack of a suitable fully HLAmatched donor limits this option for many patients. Without a suitable related or unrelated HLA-matched donor,umbilical cord blood and haploidentical family members provide a potential source of stem cells. Timely donor availability makes haploidentical donors an attractive alternative donor source. Initial attempts at haploidentical HSCT was associated with significantly increased mortality owing to high rates of graft rejection and severe graftversus-host disease caused by major donor-recipient HLAdisparity. However, over the past decade, outcomes of haploidentical HSCT have improved significantly. Here, we review the advantages and challenges of haploidentical transplantation. We also discuss new developments to attempt to overcome the challenges to a successful haploidentical transplantation.展开更多
A key issue in the haploiedntical hematopoietic stem cell transplantation(haplo-HSCT) setting is the search for the best donor, because donor selection can significantly impact the clinical outcomes. We aimed to ident...A key issue in the haploiedntical hematopoietic stem cell transplantation(haplo-HSCT) setting is the search for the best donor, because donor selection can significantly impact the clinical outcomes. We aimed to identify the role of collateral related donors(CRDs) in donor selection for haplo-HSCT through comparing the clinical outcomes between CRDs(n = 60) and maternal donors(MDs, n = 296), which were the last choice of donor selection in immediate related donors(IRDs). The cumulative incidence of graft-versus-host disease was comparable between CRDs and MDs. The 5-year cumulative incidence of relapse and non-relapse mortality was 22.0%(95% CI, 11.3%–32.7%) versus 17.4%(95% CI, 13.0%–21.8%)(P = 0.455) and 25.0%(95% CI, 13.9%–36.1%) versus 23.1%(95% CI, 18.2%–28.0%)(P = 0.721) for the CRDs and MDs, respectively. The 5-year probabilities of disease-free survival and overall survival was 53.2%(95% CI, 40.4%–66.0%) versus 59.5%(95% CI, 53.8%–65.2%)(P = 0.406) and 56.5%(95% CI,43.8%–69.2%) versus 61.8%(95% CI, 56.1%–67.5%)(P = 0.458) for the CRDs and MDs, respectively.Female donor/male recipient(FDMR) CRDs were associated with the poorest clinical outcomes, and the clinical outcomes of non-FDMR CRDs were comparable to those of MDs. In summary, our results showed that CRDs did not showed superiority over MDs. Thus, IRDs should be the first choice of donor selection, and CRDs could only be the donors for those without IRDs.展开更多
Allogeneic hematopoietic stem cell transplantation(HSCT)is one of the most effective options for hematological malignancies,and human leukocyte antigen-partially matched related donors(PMRDs)are a valuable option for ...Allogeneic hematopoietic stem cell transplantation(HSCT)is one of the most effective options for hematological malignancies,and human leukocyte antigen-partially matched related donors(PMRDs)are a valuable option for HSCT.Several protocols(with or without ex vivo T-cell depletion(TCD))have been established worldwide.TCD including CD34+positive selection and CD3/CD19 depletion has successfully overcome the human leukocyte antigen disparity.However,TCD is associated with prolonged immune deficiencies,increased risks of infectious complications,and high transplantation-related mortality.PMRD HSCT without ex vivo TCD is well developed,and numerous patients have benefitted from it.Here,we review the literature on PMRD HSCT.展开更多
目的:对造血干细胞亲缘供者内心体验和感受进行系统评价,为临床护理实践提供指导。方法:确定研究主题后,依次检索中国知网、维普、万方、PubMed、Web of Science、MedLine、PsycINFO等中英文数据库,收集关于造血干细胞亲缘供者内心体验...目的:对造血干细胞亲缘供者内心体验和感受进行系统评价,为临床护理实践提供指导。方法:确定研究主题后,依次检索中国知网、维普、万方、PubMed、Web of Science、MedLine、PsycINFO等中英文数据库,收集关于造血干细胞亲缘供者内心体验和感受等的质性研究,检索时限从建库至2020年12月30日。进一步采用澳大利亚循证卫生保健中心质性研究质量评估工具对文献进行评价,最后对结果进行整合。结果:共纳入8项相关研究,提炼出46个结果、汇总成9个新类别、3个整合结果,即捐赠造血干细胞前复杂的心理路程;捐赠过程中、过程后紧张与释怀担心交织;移植完虽感被忽视但认为给亲属塑造了重生机会。结论:医护人员应充分了解造血干细胞亲缘供者的内心体验和情感,给予亲缘供者相应的医疗技术指导和情感支持,营造积极的氛围。展开更多
文摘Allogeneic hematopoietic stem cell transplant(HSCT) remains the only potentially curative option for variety of hematologic disorders. Lack of a suitable fully HLAmatched donor limits this option for many patients. Without a suitable related or unrelated HLA-matched donor,umbilical cord blood and haploidentical family members provide a potential source of stem cells. Timely donor availability makes haploidentical donors an attractive alternative donor source. Initial attempts at haploidentical HSCT was associated with significantly increased mortality owing to high rates of graft rejection and severe graftversus-host disease caused by major donor-recipient HLAdisparity. However, over the past decade, outcomes of haploidentical HSCT have improved significantly. Here, we review the advantages and challenges of haploidentical transplantation. We also discuss new developments to attempt to overcome the challenges to a successful haploidentical transplantation.
基金supported by the Beijing Talents Fund(2015000021223ZK39)the Capital’s Funds for Health Improvement and Research(2018-4-4089)+3 种基金the Key Program of the National Natural Science Foundation of China(81530046)the Foundation for Innovative Research Groups of the National Natural Science Foundation of China(81621001)the Science and Technology Project of Guangdong Province of China(2016B030230003)the Project of Health Collaborative Innovation of Guangzhou city(201704020214)
文摘A key issue in the haploiedntical hematopoietic stem cell transplantation(haplo-HSCT) setting is the search for the best donor, because donor selection can significantly impact the clinical outcomes. We aimed to identify the role of collateral related donors(CRDs) in donor selection for haplo-HSCT through comparing the clinical outcomes between CRDs(n = 60) and maternal donors(MDs, n = 296), which were the last choice of donor selection in immediate related donors(IRDs). The cumulative incidence of graft-versus-host disease was comparable between CRDs and MDs. The 5-year cumulative incidence of relapse and non-relapse mortality was 22.0%(95% CI, 11.3%–32.7%) versus 17.4%(95% CI, 13.0%–21.8%)(P = 0.455) and 25.0%(95% CI, 13.9%–36.1%) versus 23.1%(95% CI, 18.2%–28.0%)(P = 0.721) for the CRDs and MDs, respectively. The 5-year probabilities of disease-free survival and overall survival was 53.2%(95% CI, 40.4%–66.0%) versus 59.5%(95% CI, 53.8%–65.2%)(P = 0.406) and 56.5%(95% CI,43.8%–69.2%) versus 61.8%(95% CI, 56.1%–67.5%)(P = 0.458) for the CRDs and MDs, respectively.Female donor/male recipient(FDMR) CRDs were associated with the poorest clinical outcomes, and the clinical outcomes of non-FDMR CRDs were comparable to those of MDs. In summary, our results showed that CRDs did not showed superiority over MDs. Thus, IRDs should be the first choice of donor selection, and CRDs could only be the donors for those without IRDs.
基金This work was partly supported by the National High Technology Research and Development Program of China(863 Program)(Grant No.2011AA020105)the Key Program of National Natural Science Foundation of China(Grant No.81230013).
文摘Allogeneic hematopoietic stem cell transplantation(HSCT)is one of the most effective options for hematological malignancies,and human leukocyte antigen-partially matched related donors(PMRDs)are a valuable option for HSCT.Several protocols(with or without ex vivo T-cell depletion(TCD))have been established worldwide.TCD including CD34+positive selection and CD3/CD19 depletion has successfully overcome the human leukocyte antigen disparity.However,TCD is associated with prolonged immune deficiencies,increased risks of infectious complications,and high transplantation-related mortality.PMRD HSCT without ex vivo TCD is well developed,and numerous patients have benefitted from it.Here,we review the literature on PMRD HSCT.
文摘目的:对造血干细胞亲缘供者内心体验和感受进行系统评价,为临床护理实践提供指导。方法:确定研究主题后,依次检索中国知网、维普、万方、PubMed、Web of Science、MedLine、PsycINFO等中英文数据库,收集关于造血干细胞亲缘供者内心体验和感受等的质性研究,检索时限从建库至2020年12月30日。进一步采用澳大利亚循证卫生保健中心质性研究质量评估工具对文献进行评价,最后对结果进行整合。结果:共纳入8项相关研究,提炼出46个结果、汇总成9个新类别、3个整合结果,即捐赠造血干细胞前复杂的心理路程;捐赠过程中、过程后紧张与释怀担心交织;移植完虽感被忽视但认为给亲属塑造了重生机会。结论:医护人员应充分了解造血干细胞亲缘供者的内心体验和情感,给予亲缘供者相应的医疗技术指导和情感支持,营造积极的氛围。
