摘要
自体造血干细胞移植(autologous hematopoietic stem cell transplantation,AHSCT)是高度侵袭性和复发/难治性淋巴瘤的有效治疗手段之一,可为患者带来生存获益。近年来,小分子靶向药物、单克隆抗体、细胞治疗和免疫治疗等新药给淋巴瘤患者提供了更多的选择,但AHSCT在淋巴瘤治疗中仍占据重要地位。对AHSCT适应证和治疗时机进行概述,进而详细介绍AHSCT治疗流程、移植后管理及注意事项。AHSCT的适应证和治疗时机与疾病亚型、危险分层及移植前疾病状态紧密相关。行AHSCT前,需对患者进行移植前诱导及疗效评估,诱导方案根据淋巴瘤亚型不同而有所差异,可参考相应指南推荐进行选择;目前临床中广泛使用的疗效评价标准为影像学缓解(CT/MRI评价)和代谢缓解(PET/CT评价)。AHSCT流程的每一个环节都与预后密切相关,整体流程包括干细胞动员及采集、移植前预处理、干细胞回输、合并症管理、植入情况评估。制定良好的动员策略以保证动员效果是最关键的一步,对于淋巴瘤患者,应根据诱导治疗后患者的疾病缓解状态来选择最佳的动员方案,以提高干细胞动员成功率。参考国外造血干细胞动员经验,在疾病稳定状态下,如达到CR1/CR2的患者,可优选稳态动员;针对活动复发的患者,建议优选疾病特异性的非稳态动员。针对干细胞采集目标,过往国内外临床经验多推荐外周血干细胞(peripheral blood stem cells,PBSC)的最佳目标采集量为5×10^(6)个CD34^(+)细胞/kg,近期新发表的研究结果提示,骨髓瘤患者PBSC为4.5×10^(6)~8×10^(6)个CD34^(+)细胞/kg具有更好的生存获益,淋巴瘤患者PBSC最佳阈值还有待进一步研究。自体移植物质量评价也打破了传统仅评估CD34^(+)细胞数量的模式,已有研究显示,可将自体移植绝对淋巴细胞计数(autograft absolute lymphocyte count,A-ALC)纳入到自体移植物评估中。AHSCT预处理应采用清�
Autologous hematopoietic stem cell transplantation(AHSCT)is one of the effective treatments for highly aggressive and relapsed/refractory lymphoma,which can bring survival benefits to patients.In recent years,with the advent of new drugs such as small molecule targeted drugs,monoclonal antibodies,cell therapy and immunotherapy,more choices are provided for lymphoma patients,however,AHSCT still occupies an important position in the treatment of lymphoma.This paper summarized the indications eligible for AHSCT and its timing,and introduced the treatment process,post transplantation management and precautions of AHSCT in detail.The indications and timing of AHSCT are closely related to disease subtypes,risk stratification and disease status before transplantation.Before AHSCT,patients need to undergo pre-transplant induction and efficacy evaluation.The induction scheme varies according to different lymphoma subtypes,which can be selected according to the recommendations of corresponding guidelines.Currently the widely used clinical efficacy evaluation standard is imaging remission(CT/MRI evaluation)and metabolic remission(PET/CT evaluation).Every step of the AHSCT process is closely related to posttransplant outcome and prognosis.The overall process includes stem cell mobilization and collection,pretreatment prior to transplantation,stem cell reinfusion,comorbidity management and implantation evaluation.Formulating a good mobilization strategy to ensure the smooth development of transplantation is the most critical step.It is reasonable to choose stem cell mobilization regimen according to disease status after induction therapy,which is beneficial to improve mobilization success rate.Referring to the experience of hematopoietic stem cell mobilization abroad,steady-state mobilization is preferred in patients with stable disease,such as patients with CR1/CR2;in terms of stem cell collection,previous clinical experiences domestically and abroad mostly recommend that the optimal target collection of peripheral blood ste
作者
金正明
JIN Zhengming(The First Affiliated Hospital of Soochow University,Jiangsu Institute of Haematology,China National Clinical Research Center for Blood System Diseases,Suzhou 215006,Jiangsu Province,China)
出处
《中国癌症杂志》
CAS
CSCD
北大核心
2022年第2期161-171,共11页
China Oncology
关键词
淋巴瘤
自体造血干细胞移植
临床实践
Lymphoma
Autologous hematopoietic stem cell transplantation
Clinical practice
