异基因造血干细胞移植治疗老年急性髓系白血病  

Allogeneic hematopoietic stem cell transplantation for elderly patients with acute myeloid leukemia

作　　者：刘静[1] 张晓辉[1] LIU Jing;ZHANG Xiaohui(National Clinical Research Center,Peking University Institute of Hematology,Beijing,100044,China)

机构地区：[1]国家临床医学中心,北京大学血液病研究所,北京100044

出　　处：《临床血液学杂志》2023年第9期611-614,共4页Journal of Clinical Hematology

摘　　要：高危急性髓系白血病(acute myeloid leukemia,AML)和低中危AML老年患者治疗后仍存在微小残留病变者,异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)仍是重要推荐之一,也是唯一可能实现治愈的途径。目前报道的60岁以上行allo-HSCT的老年患者长期生存率在30%~60%,这表明allo-HSCT是老年AML患者可行的治疗方法。然而老年人的身体状况和耐受性较差,因此拟行allo-HSCT的老年AML患者需要进行危险度分层和个人状况等一系列评估。除了使用目前应用于移植领域的各项评分,还应在移植前做老年评估。老年患者做allo-HSCT时更关注移植相关并发症,其中减少预处理药物毒性是一项重要策略。在供者选择方面,研究发现选择同胞全相合供者进行移植的老年患者的移植相关死亡率、总生存率和复发率并没有优于单倍体移植。也有报道显示老年急性白血病患者接受子代移植的移植相关死亡率明显低于同胞全相合造血干细胞移植。随着新型靶向药物的不断问世,allo-HSCT与新型靶向药物融合为老年患者接受移植带来了更加光明的未来。Despite treatment,elderly patients with high-risk and low-to-intermediate-risk acute myeloid leukemia(AML)may still have minimal residual disease.Allogeneic hematopoietic stem cell transplantation(allo-HSCT)remains an important recommended treatment with the only cure potential.Currently,it is reported that the overall survival for elderly patients aged 60 and above who underwent allo-HSCT was from 30%to 60%,which indicates that allo-HSCT is an available treatment for elderly AML patients.However,due to poor physical condition,elderly patients who are going to receive allo-HSCT have to make a series of assessments,including disease risk stratification and evaluation of individual conditions.In addition to utilizing various scoring systems currently applied in allo-HSCT,a geriatric assessment should also be conducted.More attention has to be paid on transplant-related complications for elderly patients who are going to undergo allo-HSCT.It is an important strategy to reduce the toxicity of conditioning regimen.Transplant experts worldwide are exploring the impact of different conditioning regimens on outcomes for elderly transplant recipients.Regarding donor selection,elderly AML patients who received fully matched sibling donor allo-HSCT did not achieve better outcomes on transplantrelated mortality,overall survival,and relapse rates compared to patients who received haploidentical donor allo-HSCT.Another report indicated that elderly patients with acute leukemia who received grafts from an offspring donor had significantly lower transplant-related mortality compared to those who received grafts from fully matched sibling donors.With the emergence of novel targeted therapies,the integration of allo-HSCT with these new agents brings a brighter future for elderly AML patients.

关 键 词：老年急性髓系白血病 异基因造血干细胞移植 预处理方案 供者选择 新型靶向药物 

分 类 号：R457.7[医药卫生—治疗学]