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골수형성이상증후군의 동종조혈모세포이식 치료

Allogeneic hematopoietic stem cell transplantation for myelodysplastic syndromes

김유진
대한내과학회 (The Korean Association Of Internal Medicine)|2009.02|대한내과학회지 (The Korean Journal of Medicine)|제76권 제2호|pp. 126-136

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참고문헌

키워드

골수형상이상증후군; 동종조혈모세포이식Myelodysplastic syndromes; Allogeneic hematopoietic stem cell transplantation
주제분류내과학

초록

Allogeneic hematopoietic stem cell transplantation (HCT) offers potentially curative therapy for patients with myelodysplastic syndromes (MDS). However, who should and can be transplanted, with which approach, and when is a matter of debate. Even with the recent advances in the field of HCT, more than 50% of the patients failed to benefit from transplantation either due to treatment-related mortality or to relapse. Disease stage, patient age, comorbidity, pre-transplant chemotherapy, type of donor, source of stem cells, and possibly other factors, need to be considered to decide to perform transplantation in an individual patient. Offering HCT to patients who were not candidates for transplant in the past is now possible with the development of new transplant strategies. The introduction of reduced-intensity conditioning has significantly reduced the treatment-related mortality but did not affect the risk of relapse. New effective drugs, such as hypomethylating agents, histone-deacetylase inhibitors or lenalidomide, can be used alone or in combination to reduce MDS burden before HCT or to prevent relapse after transplantation as maintenance or consolidation therapy. And also, immunotherapy can be adopted to improve transplant outcomes.

Abstract

Allogeneic hematopoietic stem cell transplantation (HCT) offers potentially curative therapy for patients with myelodysplastic syndromes (MDS). However, who should and can be transplanted, with which approach, and when is a matter of debate. Even with the recent advances in the field of HCT, more than 50% of the patients failed to benefit from transplantation either due to treatment-related mortality or to relapse. Disease stage, patient age, comorbidity, pre-transplant chemotherapy, type of donor, source of stem cells, and possibly other factors, need to be considered to decide to perform transplantation in an individual patient. Offering HCT to patients who were not candidates for transplant in the past is now possible with the development of new transplant strategies. The introduction of reduced-intensity conditioning has significantly reduced the treatment-related mortality but did not affect the risk of relapse. New effective drugs, such as hypomethylating agents, histone-deacetylase inhibitors or lenalidomide, can be used alone or in combination to reduce MDS burden before HCT or to prevent relapse after transplantation as maintenance or consolidation therapy. And also, immunotherapy can be adopted to improve transplant outcomes.

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