혈액질환에서의 새로운 조혈모세포이식 기법
New therapeutic modalities on hematopoietic stem cell transplantation
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초록
조혈모세포이식은 재생불량성 빈혈과 같은 골수기능부전 환자의 조혈기능을 회복시킬 수 있는 치료이며, 혈액암 환자에서는 잔존 백혈병세포를 제거하고 이식편대항종양 효과를 유도하여 완치율을 증가시킬 수 있는 치료방법이다. 이전에는 HLA 일치 공여자를 구할 수 없거나, 고령이나 기왕증 등의 문제로 강력한 전처치를 받을 수 없는 환자들은 이식이 불가능하였으나, 이를 극복하기 위한 노력과 연구의 결과로 비골수제거 조혈모세포이식과 제대혈이식, HLA 부분 불일치 혈연간 조혈모세포이식이 가능해져 치료영역이 확대되었다. 그러나 생착부전, 감염, 이식편대숙주병 등의 문제는 완전히 해결되지 않았기 때문에 앞으로 보다 많은 연구가 필요하다.
Abstract
Hematopoietic stem cell transplantation (HSCT) has been used to treat a variety of non-malignant and malignant lymphohematopoietic disease. But, there are many obstacles in performing HSCT for patients who do not have a human leukocyte antigen (HLA)-matched donor or are not eligible for HSCT because of old age and comorbidities. A better understanding of transplantation biology led to the development of non-myeloablative stem cell transplantation, HLA-haploidentical stem cell and umbilical cord blood (UCB) transplantation. Non-myeloablative stem cell transplantation is being commonly used in older patients as well as in disorders due to their safety and therapeutic effect. For patients without a matched HLA-identical sibling or unrelated donor, other graft sources, such as UCB and HLA-haploidentical donors, have been used. Transplantation using UCB is used in child transplantation, but it is not always suitable for adult transplantation because of insufficient cell doses. Transplantation of the stem cells from HLA-haploidentical donors emerges as an alternative source for acute leukemia patients without matched donors, but it is faced with the difficulties of graft rejection, GVHD and delayed immune reconstitution. It is necessary to overcome these difficulties through further studies.
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