Hematopoietic stem cell HSC transplantation HSCT is an effective treatment for hematological malignant diseases. Pretreatment before transplantation is an important part of the HSCT process. On the one hand, the pretreatment can eliminate malignant tumor cells in the body to provide sufficient growth for normal HSC implantation On the other hand, pretreatment can suppress the immune system of the recipient to make it unable to reject the graft and make the transplant successful. In recent years, the transplantation indication has gradually expanded with the continuous development of transplantation technology. When did the chronic lymphocytic leukemia CLL undergo transplantation?
To further regulate this requires more donors to provide suitable HSCs. Since the establishment of the National Bone Marrow Bank (NMDP) more than 20 years ago, the number of volunteers has been increasing. The number of volunteers has exceeded 7 million in 2008. To date, NMDP has exceeded 30,000. Cases of patients waiting to be transplanted found a suitable donor. The current donor HSC is more than 3,500. The Chinese bone marrow bank in China exceeded 1 million volunteer data in August 2009, plus the Tzu Chi bone marrow database in Taiwan. There are more than 1.3 million volunteer data for our patients to retrieve. At the same time, Chinese scholars have made fruitful explorations on haplotype matching relative donor transplantation. The source of transplanted donors is no longer a problem, but how to further optimize the pretreatment program to ensure the donor HSC The successful transplantation inhibits transplant rejection while maximizing the killing of tumor cells and reducing their adverse reactions, improving the success rate of transplantation and the long-term survival rate of patients. This has always been a major problem that plagues transplant workers. This paper's research progress on pretreatment in recent years Make a discussion.
With the advancement of transplantation technology and basic medicine, more and more new drugs have been applied to transplantation pretreatment programs in recent years, such as ATG bortezomib monoclonal antibody, etc. and have shown good application prospects.
A large prospective randomized, open, multi-center phase III clinical trial was recently conducted in Europe to compare the transplantation of unrelated donors with a standard GVHD prophylactic regimen based on cyclosporine and methotrexate with or without ATG The results showed that the incidence of acute and chronic GVHD was significantly reduced after the addition of ATG. The recurrence rate was not increased by NRM. The OS rate was not increased. ATG was applied to HSCT patients with unrelated donors who were effective. The results showed that the low-dose ATG total dose of 2.5 mg / kg in incompatible donor transplantation can prevent the occurrence of moderate to severe acute GVHD without increasing the recurrence rate and the infection rate of cytomegalovirus CMV and reducing NRM.
The Seattle research group recently studied the efficacy of I 131-labeled anti-CD45 antibody as a pretreatment drug. The subjects were advanced AML and high-risk myelodysplastic syndrome MDS patients. All 58 patients were all> 50 years old. 5% of patients accounted for 86%. The pretreatment protocol was anti-CD45 antibody Flu with I 131 and TBI 2 Gy. All patients reached 28 days after CR. CD3 and CD33 positive cells in peripheral blood of patients were all 100%. At time d, 7 cases of 12% of patients died of non-recurring causes. The expected 1-year tumor recurrence rate is 40%, and the 1-year survival rate is more than 41%. The results indicate that it is safe to use CD45 as the target radiotherapy combined with RIC regimen. The post-OS rate for patients with high-risk AML or MDS in the elderly is encouraging.
Therefore, the so-called non-myeloablative or reduced-dose and myeloablative pretreatment is only relatively speaking and there is no absolute boundary. The so-called standard pretreatment is not clearly defined. The pretreatment program of each transplanted patient should be analyzed in detail. The pretreatment program should be optimized to improve the clearance rate of tumor cells, enhance the GVL / T effect, reduce the incidence of severe GVHD and the recurrence rate of primary disease after transplantation to improve survival rate and Quality of life benefits more patients
With the advancement of HSCT technology, transplantation indications continue to increase. According to EBMT, the transplantation of unrelated donors in Europe has been matched with HLA in 2007. The number of donor transplants is equal. How to find the most suitable donor for patients. The goal of our efforts to explore in recent years. With the continuous progress of basic medical research, HLA matching has evolved from the traditional serological level to the current molecular level, which greatly improves the matching accuracy. It guides us to choose the best donor and some new ones. The establishment of transplantation programs and the application of new drugs in pretreatment programs will greatly improve the transplantation effect. However, due to the diversity of clinical patients, there is no one pretreatment program that is suitable for all patients. The effect of transplantation and the age of the patient are important. Many other factors are closely related
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