骨髓增生异常综合征患者最佳移植时机选择

石威; 夏凌辉; 胡豫

doi:10.13201/j.issn.1004-2806.2023.11.012

骨髓增生异常综合征患者最佳移植时机选择

- 华中科技大学同济医学院附属协和医院血液病研究所(武汉，430022)
基金项目:
国家自然科学基金(No：82370220)

详细信息

通讯作者: 石威，E-mail：shiwei076@hust.edu.cn

中图分类号: R733

收稿日期: 2023-09-11

刊出日期: 2023-11-01

Selection of optimal time for transplantation in patients with myelodysplastic syndrome

- Institute of Hematology, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, China

More Information

Corresponding author: SHI Wei, E-mail: shiwei076@hust.edu.cn

Received Date: 11 September 2023

Publish Date: 01 November 2023

摘要

摘要: 骨髓增生异常综合征是一组异质性很强的髓系克隆性疾病，分型众多而治疗原则各异，异基因造血干细胞移植的时机把握属于临床难题。首先基于危险分层来确定低危或较高危患者对于区分移植时机十分关键。应尽量选择KPS≥80%和HCT-CI＜3作为适合移植人群的候选标准。对于较高危患者应尽快直接进行移植，不必拘泥于原始细胞比例问题。较低危患者应在常规治疗疗效不佳，或疾病进展，或严重血细胞减少或输血依赖时进行。较低危患者若存在不良遗传学异常或高危基因突变，也应尽快接受异基因造血干细胞移植，IPSS-M积分对这一类患者有重要的提示作用。
- 骨髓增生异常综合征 /
- 异基因造血干细胞移植 /
- 移植时机 /
- 危险分层
Abstract: Myelodysplastic syndrome is a group of myeloid clonal diseases with strong heterogeneity. It is a clinical problem to grasp the best timing of allogeneic hematopoietic stem cell transplantation(allo-HSCT). First identifying low-risk or higher-risk patients based on prognostic score systems is critical to distinguishing the timing of transplantation. KPS≥80% and HCT-CI < 3 should be selected as the candidate criteria for transplant population. For higher-risk patients, allo-HSCT should be performed as soon as possible, no need for bridging therapy. Lower-risk patients should be treated when conventional treatment is not effective, or when the disease is progressing, or when severe cytopenias or transfusion dependence. Lower-risk patients with adverse genetic abnormalities or high-risk gene mutations should also receive allo-HSCT as soon as possible. IPSS-M score may have an important prompting effect on such patients.
- myelodysplastic syndrome /
- allogeneic hematopoietic stem cell transplantation /
- transplantation timing /
- risk stratification

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图 1 MDS患者进入allo-HSCT的诊疗流程

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参考文献(24)

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