异基因造血干细胞移植最佳供者选择:HLA相合同胞供者总是首选吗?  

Best donor selection in allogeneic hematopoietic stem cell transplantation settings: should human leukocyte antigen-matched sibling donor always be selected first?

作　　者：吴蔚冰 常英军[1] WU Wei-bing;CHANG Ying-jun(Reking Universily People's Hospital&Peking University Institute of Hematology,National Clinical Research Center for Hematologic Disease,Beijing Key Liboratory of Hematopoietic Stem Cell Transplantation,Beijing 100044,China)

机构地区：[1]北京大学人民医院北京大学血液病研究所国家血液系统疾病临床医学研究中心造血干细胞移植治疗血液病北京市重点实验室,北京100044

出　　处：《中国实用内科杂志》2021年第4期272-278,共7页Chinese Journal of Practical Internal Medicine

基　　金：京津冀协同创新推动项目(Z181110009618032)。

摘　　要：尽管单倍型相合造血干细胞移植(Haplo-HSCT)治疗恶性血液病获得了与人类白细胞(HLA)相合同胞供者移植(MSDT)相当的疗效,但由于MSDT较Haplo-HSCT具有造血和免疫重建快、感染发生率低等优点,HLA相合同胞供者仍是国内外学者公认的首选供者来源。近年来,部分研究证实Haplo-HSCT治疗移植前微小残留病(MRD)阳性的急性白血病(AL)等亚组人群较MSDT具有更强的移植物抗白血病作用,文章就移植前MRD阳性AL等恶性血液病亚组人群的最佳供者选择进行了讨论,并提出应该首选单倍型相合供者,而不是HLA相合同胞供者。Human leukocyte antigen(HLA)-matched sibling donor remains the first choice in allogaft settings due to HLA-identical sibling donor transplantation(MSDT) has some advantages,such as faster hematological and immunological recovery and lower incidences of infections,compared with those of haploidentical hematopoietic stem cell transplantation(Haplo-HSCT),although treating hematological malignancies with Haplo-HSCT can achieved comparable outcomes to those of MSDT. Recently,a number of studies confirmed that there was a stronger graft-versus-leukemia effect after treating several subgroup cases of hematological malignancies,such as pre-transplantation minimal residual disease(pre-MRD)positive acute leukemia,with Haplo-HSCT than that of MSDT. Here,we discussed the issue on who is the best donor for some subgroup patients with hematological maliganancies,including pre-MRD positive acute leukemia. We also suggest that for these cases,haploidentical donor but not HLA-matched sibling donor should be selected first.

关 键 词：单倍型相合移植 HLA相合同胞供者移植 恶性血液病 移植物抗白血病 

分 类 号：R557[医药卫生—血液循环系统疾病]