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异基因干细胞移植用于实体瘤的治疗有很大的潜力。传统的清髓性造血干细胞移植采用大剂量化疗药物对受者进行预处理,虽然起到一定的杀伤肿瘤细胞作用,但增加了移植相关死亡率(transplant-related mortality,TRM)。随着对非清髓性预处理的深入研究,人们将非清髓性造血干细胞移植用于实体瘤的治疗。与清髓性干细胞移植比较,非清髓性移植减轻了TRM,且拓宽了移植适应证。移植物抗宿主病(graft versus host disease,GVHD)是异基因移植后出现的毒性反应,甚至成为致命性的并发症。移植物抗肿瘤(graft versus tumor,GVT)效应是异基因移植治疗实体瘤的关键,而GVT效应常伴随GVHD的出现。因此,如何在保留GVT效应的同时降低GVHD是我们所面临挑战。目前,通过改变预处理方案、加强对移植物的处理、改变免疫抑制疗法等3种策略使用于GVHD的防治,取得了一定效果,为异基因造血干细胞移植治疗实体瘤带来了广阔前景。
Allogeneic stem cell transplantation for the treatment of solid tumors have great potential. Traditional myeloablative hematopoietic stem cell transplantation using high-dose chemotherapy drugs for pretreatment of recipients, although a certain role in killing tumor cells, but increased transplant-related mortality (transplant-related mortality, TRM). With an in-depth study of non-myeloablative preconditioning, nonmyeloablative hematopoietic stem cell transplantation has been used to treat solid tumors. Compared with myeloablative stem cell transplantation, nonmyeloablative transplantation reduces TRM and broadens the indications for transplantation. Graft versus host disease (GVHD) is a toxic reaction after allogeneic transplantation and may even become a fatal complication. The graft versus tumor (GVT) effect is the key to allogeneic transplantation in the treatment of solid tumors, while the GVT effect is often accompanied by the appearance of GVHD. Therefore, how to reduce GVHD while retaining the GVT effect is the challenge we face. At present, we have achieved some results by changing the pretreatment program, strengthening the treatment of the graft, changing the immunosuppressive therapy and other three strategies for the prevention and treatment of GVHD, which has brought broad prospects for allogeneic hematopoietic stem cell transplantation for the treatment of solid tumors.