摘要
背景:异基因造血干细胞移植仍然是获得性重型再生障碍性贫血患者的唯一治愈方法,如何选择适合移植的重型再生障碍性贫血患者进行治疗成为近年的研究热点。目的:从HLA全相合无关供者造血干细胞移植、非血缘脐血移植和单倍体相合造血干细胞移植3个方面进行综述,阐述异基因造血干细胞移植的研究进展。方法:检索2000至2018年期间收录在PubMed、中国知网期刊全文数据库及万方数据库中异基因造血干细胞移植治疗重型再生障碍性贫血的相关文献,检索词为“unrelated donor,haploidentical,unrelated cord blood,severe aplastic anemia”及“无关供者,单倍体相合,无血缘脐血,重型再生障碍性贫血”。结果与结论:①HLA全相合同胞供者造血干细胞移植是治疗重型再生障碍性贫血的一线治疗方案,但鉴于HLA相合同胞供者不易寻找,HLA全相合无关供者造血干细胞移植作为重要的替代治疗手段,目前疗效已接近HLA全相合同胞供者造血干细胞移植,但移植物抗宿主病、严重感染的发生率仍高于HLA全相合同胞供者造血干细胞移植,在选择HLA全相合无关供者造血干细胞移植治疗时仍然需要多因素综合考虑;②脐血造血干细胞来源丰富且配型成功率高,使得非血缘脐血移植的应用变得普遍,预冻存总有核细胞量>3.9×107/kg时非血缘脐血植入概率较高,但鉴于非血缘脐血植入延迟、免疫功能重建延迟等因素,临床治疗重型再生障碍性贫血时只有在其他移植方式不可行且第1个疗程免疫抑制治疗失败后才应考虑非血缘脐血移植;③单倍体相合造血干细胞移植具有供者易获得且依从性好等优点,疗效接近全相合移植,现已成为一种重要的替代移植选择;巴利昔单抗和(或)抗胸腺细胞球蛋白的使用有望降低移植物抗宿主病的发生率以拓展单倍体相合造血干细胞移植的临床应用范围。
BACKGROUND:Allogeneic hematopoietic stem cell transplantation is still the only cure method for acquired severe aplastic anemia.How to select patients for treatment has become a research hotspot in recent years.OBJECTIVE:To review the progress of allogeneic hematopoietic stem cell transplantation from three aspects:HLA full-phase matched unrelated donor hematopoietic stem cell transplantation(MUD-HSCT),unrelated cord blood transplantation(UCBT)and haploidentical hematopoietic stem cell transplantation(HID-HSCT).METHODS:Literatures on allogeneic hematopoietic stem cell transplantation for severe aplastic anemia collected in PubMed,CNKI full-text database and WanFang database from 2000 to 2018 were retrieved with the keywords“unrelated donor;haploidentical;unrelated cord blood;severe aplastic anemia”in Chinese and English.RESULTS AND CONCLUSION:MSD-HSCT is the first-line treatment for severe aplastic anemia,but in view of China’s special national conditions,HLA matched donor is not easy to find.As an important alternative treatment,MUD-HSCT is close to MSD-HSCT.However,the incidence of graft versus host disease and severe infection after MUD-HSCT is still higher than that after MSD-HSCT.It is still necessary to consider multiple factors when choosing MUD-HSCT treatment.Umbilical cord blood hematopoietic stem cells are widely used because of their abundant sources and high match success rate.The probability of UCBT is very high when the amount of pre-frozen total nucleated cells is more than 3.9×107/kg.However,in view of the delay of UCBT and immune function reconstruction,unless other transplantation methods are not feasible in clinical treatment of severe aplastic anemia and immunosuppressive therapy fails in the first course of treatment,UCBT should not be considered.HID-HSCT has the advantages of easy access and good compliance of donors and is close to full-matched transplantation.It has become an important alternative to transplantation.The use of baliximab and/or antithymocyte globulin is expected to r
作者
丁宇斌
唐玉凤
唐旭东
Ding Yubin;Tang Yufeng;Tang Xudong(Department of Hematology,Xiyuan Hospital Affiliated to China Academy of Chinese Traditional Sciences,Beijing 100091,China;Department of Laboratory Medicine,Xiyuan Hospital Affiliated to China Academy of Chinese Traditional Sciences,Beijing 100091,China)
出处
《中国组织工程研究》
CAS
北大核心
2020年第19期3084-3092,共9页
Chinese Journal of Tissue Engineering Research
基金
国家中医药管理局中医药行业科研专项(201507001-13)，项目负责人：唐旭东
国家自然科学基金青年基金(81303127)，项目负责人：唐旭东
国家自然科学基金面上项目(81673819)，项目负责人：唐旭东~~
