异基因造血干细胞移植治疗恶性淋巴瘤的临床研究新进展.pdfVIP

1564 中国肿瘤临床 2012年第39卷第20期 · · 综 述 异基因造血干细胞移植治疗恶性淋巴瘤 的临床研究新进展 张 乐 综述 张翼鷟 审校 摘要 异基因移植（allo-SCT）已越来越多的应用于治疗淋巴瘤患者，作为治疗淋巴瘤的又一有效手段，为常规治疗效果不 佳的患者提供了新的治疗策略。过去，标准清髓性异基因造血干细胞移植（standardmyeloablativeallogeneticstem-celltransplanta⁃ tion，MAC-allo-SCT）由于移植相关死亡率（TRM）较高而限制了其临床应用。近十年来，越来越多的淋巴瘤患者接受降低预处理 强度（RIC）异基因造血干细胞移植，毒性和移植相关死亡率均大大降低。异基因移植后较低的复发率和供者淋巴细胞输注的结 果均证明移植物抗淋巴瘤（GVL）效应的存在，有利于清除微小残留病灶（MRD），增加治愈的机会。虽然目前降低预处理强度 （RIC）的造血干细胞移植大大降低了移植相关死亡率（TRM），也改善了一些淋巴瘤患者的生存率；但是HL、侵袭性B细胞淋巴 瘤，以及经高强度预先治疗的淋巴瘤和难治性淋巴瘤的复发率仍然居高不下，无疑需要进一步的改善。因此，大型的前瞻性研究 对深入明确allo-SCT在淋巴瘤治疗中的应用是必要的。现将allo-SCT近几年在治疗HL、惰性淋巴瘤和侵袭性淋巴瘤（包括套细 胞淋巴瘤和成熟T细胞淋巴瘤）的进展综述如下。 关键词 异基因移植 霍奇金淋巴瘤 惰性淋巴瘤 侵袭性淋巴瘤 进展 doi:10.3969/j.issn.1000-8179.2012.20.027 A Review of the New Progress in Treatment of Lymphoma with Allo-SCT Le ZHANG, Yizhuo ZHANG Correspondence to: Yizhuo ZHANG; E-mail: aprilzyz@ Department of Hematologic Neoplasms, Tianjin Medical University Cancer Institute and Hospital, Key Laboratory of Cancer Prevention and Treatment of Tianjin City, Tianjin 300060, China Abstract Allogeneic hematopoietic stem cell transplantation (allo-HSCT) is increasingly being used to treat patients with lymphoma. As another effective treatment for lymphoma, allo-HSCT is a new treatment strategy for the poor conventional treatment patients. Historically, high levels of treatment-related mortality restricted the use of standard myeloablative allogeneic stem-cell transplantation. Over the last - decade, an increasing number of patients with lymphoma have undergone allogeneic stem-cell transplantation (allo-SCT) using re duced-intensity protocols that are associated with lower toxicity and reduced transplantation-related mortality. A graft-versus-lymphoma (GvL) effect is present in most entities, as evidenced by the generally lower relapse rates after allo-SCT and the results of do