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造血干细胞移植生存概述

Author
Corey Cutler, MD, MPH, FRCP(C)
Section Editor
Larissa Nekhlyudov, MD, MPH
Deputy Editor
Alan G Rosmarin, MD
Translators
魏嘉璘, 副主任医师

引言

造血干细胞移植(hematopoietic cell transplantation, HCT)是指给予来自于任何来源(如，骨髓、外周血和脐带血)或供者(如，异基因的和自体的)的造血祖细胞以重建骨髓功能。自体HCT使用的是来源于患病个体自身的造血祖细胞。相比之下，异基因HCT使用的是从其他非患病个体采集的造血祖细胞。自体和异基因HCT被越来越多地用于治疗多种血液系统肿瘤、良性骨髓疾病及遗传性代谢病。每年全球进行的HCT超过40,000例。

与HCT数量增加相应的是，异基因移植结局方面已有了稳定改善，这主要与人类白细胞抗原(human leucocyte antigen, HLA)配型改进、支持性治疗改善及感染性疾病治疗进展有关。因此，HCT长期生存者数量不断增加，并且移植机构已认识到了为这些个体提供专业护理的重要性。 (参见“造血干细胞移植后的支持治疗”，关于‘估计死亡风险’一节)

已接受自体HCT患者的生存质量普遍极好。类似地，大多数异基因HCT长期生存者有工作并且健康状态良好，且具有可接受的主观和客观功能。然而，HCT过程使这些患者暴露于高毒性治疗中，并使他们有发生若干长期并发症的风险，而这些并发症在常规剂量化疗和/或放疗后通常不会被观察到。此外，异基因移植受者易受慢性移植物抗宿主病(graft-versus-host disease, GVHD)的长期影响，即使是在静止或缓解期，GVHD也可能需要持续多年的专业医护。 (参见“造血干细胞移植后的生存质量”和“慢性移植物抗宿主病的临床表现、诊断和分级”)

本专题将提供关于HCT生存者护理的概述，且重点集中于HCT后约1年时需要注意的问题。移植早期并发症的特定治疗、急性及慢性GVHD的临床处理、针对特定疾病的长期随访，以及HCT后继发性恶性肿瘤的更深入讨论，将在别处讨论。 (参见“造血干细胞移植后的支持治疗”和“造血干细胞移植后的造血支持”和“急性移植物抗宿主病的预防”和“慢性移植物抗宿主病的治疗”和“造血干细胞移植后的恶性肿瘤”)

术语

HCT是一种通用术语，指的是患者接受化疗和/或放疗(即“预处理方案”)后输注造血祖细胞的多种操作。根据造血细胞的供者、造血祖细胞的来源和预处理方案，HCT可大概分成若干亚型。这些因素每一个都可影响操作相关的疗效和短期及长期毒性。

                           

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Literature review current through: 2017-06 . | This topic last updated: 2017-03-22.
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