nodgoРоссийский журнал детской гематологии и онкологии (РЖДГиО)Russian Journal of Pediatric Hematology and Oncology2311-12672413-5496LTD “Graphica”10.17650/2311-1267-2017-4-2-46-69nodgo-295Research ArticleОригинальные исследованияАллогенная трансплантация гемопоэтических стволовых клеток: перспективы и альтернативы, собственный опытAllogeneic transplantation of hematopoietic stem cells: Perspectives and alternatives, own experienceПопВ. П.PopV. P.

105229, Москва, Госпитальная площадь, 3

3 Gospital’naya Area, Moscow, 105229

vasiliypop@mail.ruРукавицынО. А.RukavitsynO. A.

105229, Москва, Госпитальная площадь, 3

3 Gospital’naya Area, Moscow, 105229

ФГКУ «Главный военный клинический госпиталь им. акад. Н.Н. Бурденко» Минобороны РоссииРоссияN.N. Burdenko Main Military Clinical Hospital, Ministry of Defense of RussiaRussian Federation201716062017424669Copyright © Поп В.П., Рукавицын О.А., 20172017Поп В.П., Рукавицын О.А.Pop V.P., Rukavitsyn O.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://journal.nodgo.org/jour/article/view/295Цель

Цель. Трансплантация гемопоэтических стволовых клеток (ТГСК) используется для обеспечения возможности излечения злокачественных онкогематологических заболеваний, некоторых солидных опухолей и аутоиммунных заболеваний. Целью обзора является суммирование основных данных о развитии и перспективе ТГСК, изучении новых возможностей, а также развивающихся альтернативных технологиях, усиливающих эффективность противоопухолевого потенциала аллогенной ТГСК (алло-ТГСК), и одновременно уменьшающих риски ее тяжелых осложнений.

Основные положения

Основные положения. Алло-ТГСК как форма иммунотерапии способствует длительным ремиссиям, но все еще ограничена связанными с трансплантацией заболеваемостью и смертностью из-за токсических эффектов на организм, инфекционных осложнений и реакции «трансплантат против хозяина» (РТПХ). Разработаны различные методы, уменьшающие побочные эффекты ТГСК. Одними из основных достижений последнего времени явились успехи в гаплоидентичной трансплантации, которая на основе новых возможностей профилактики РТПХ не только стала доступна почти для всех подходящих пациентов, но и не уступает стандартной алло-ТГСК по эффективности и безопасности. Успешно внедряется алло-ТГСК после редуцированной интенсивности кондиционирования или немиелоаблативных режимов при лечении пожилых или ослабленных пациентов с распространенными стадиями гематологических злокачественных заболеваний. Показано, как новые технологии усиливают эффективность противоопухолевого потенциала алло-ТГСК, и одновременно уменьшают риски ее тяжелых осложнений. Представлен собственный опыт алло-ТГСК у 19 пациентов. В нашем исследовании показано, что алло-ТГСК не улучшила исход для рефрактерных/рецидивирующих пациентов с острыми лейкозами, но может быть с успехом использована в фазу ремиссии.

Выводы

Выводы. Роль стволовых клеток в лечении гематологических и негематологических злокачественных заболеваний (а также некоторых аутоиммунных состояний) постоянно возрастает. Всесторонние знания о возможностях применения трансплантационных технологий, современных методах клеточной терапии гемобластозов позволят уменьшить лекарственную токсичность и улучшить исходы пациентов. 

Rationale

Rationale. Hematopoietic stem cell transplantation (HSCT) providing possibility to cure malignant oncohematological diseases, selected solid tumors and autoimmune disorders. Aim of review is summarizing of major data on development and perspective of HSCT, studying of new possibilities and developing alternative technologies improving effectiveness of anti-leukemia potential of allogenic HSCT (allo-HSCT) and, at the same time, decreasing of risk of severe complications.

General statues

General statues. Allo-HSCT as a method of immunotherapy contributes prolonged remissions, but still limited transplant related morbidity and mortality due to toxic effects on body, infection complications and “graft-versus-host” disease (GvHD). Different methods decreasing side effects of HSCT have been developed. One of the major recent achievements are the successes in haploidentical transplants, which based on the new approaches of GvHD prophylaxis and became accessible almost for all suitable patients and do not concede of standard alloHSCT on efficacy and safety. Allo-HSCT after reduced intensity conditioning or non-myeloablative conditioning for treatment of elderly or weakened patients with advanced stages of hematological malignant disorders have successfully implemented. It was shown how the new technologies enhancing effectiveness of anti-tumor potential allo-HSCT and simultaneously decreases the risks of severe complications. Own experience of allo-HSCT at 19 patients presented. It was shown in our study that allo-HSCT did not improved outcome for refractory/ relapsing patients with acute leukemias, but can be successfully used in remission phase.

Conclusion

Conclusion. Role of stem cells in treatment of haematological and non-hematological malignant diseases (as well as some autoimmune disorders) continuously growing. Comprehensive knowledge on possibilities of usage of transplant technologies, modern methods of cell therapy of leukemias allows to decrease drug toxicity and improve the patients’ outcomes.

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The authors declare that there are no conflicts of interest present.