减低剂量预处理异基因造血干细胞移植治疗骨髓增生异常综合征的研究进展

异基因造血干细胞移植(allo-HSCT)为可能治愈国际预后积分系统(IPSS)中、高危骨髓增生异常综合征(MDS)患者的方法.然而,MDS患者多为中、老年人,难以耐受清髓性异基因造血干细胞移植(MAC-HSCT).减低剂量预处理异基因造血干细胞移植(RIC-HSCT)具有低毒、高效等特点,被广泛应用于MDS的治疗.目前,常用的预处理方案为氟达拉滨联合烷化剂,但各种预处理方案的疗效差异较大.RIC-HSCT对IPSS中、高危老年MDS患者有其独特优势,但不同移植类型、allo-HSCT前肿瘤负荷、IPSS危险度分层及移植前合并症对RIC-HSCT疗效的影响尚无定论.笔者拟就近年来RIC-HSCT应用于MDS治疗的研究进展进行综述.

Research progress of reduced-intensity conditioning allogeneic hematopoietic stem cell transplantation in treatment of myelodysplastic syndrome

Allogeneic hematopoietic stem cell transplantation(allo-HSCT) is likely to be the optimum method to cure international prognostic scoring system (IPSS) intermediate and high-risk patients with myelodysplastic syndrome(MDS).However,patients suffered with MDS are usually too old to undergo myeloablative conditioning allogeneic stem cell transplantation(MAC-HSCT).On account of its advantages of higher efficiency and lower toxicity,reduced intensity conditioning allogeneic stem cell transplantation (RIC-HSCT) is widely applied in the treatment of MDS patients.Currently,fludarabine plus alkylating regimens are widely applied,but the clinical outcomes are different from each regimen.Although RIC-HSCT has unique advantages in treating intermediate and high-risk elder MDS compared with MAC-HSCT and non-HSCT therapy,whether the outcome is influenced by factors such as tumor burden,recipient age,IPSS risk stratification,type of allo-HSCT,and comorbidity before transplantation is still unclear.In this article,we review literatures on RIC-HSCT in treatment of MDS.