Аллогенная трансплантация гемопоэтических стволовых клеток: перспективы и альтернативы, собственный опыт

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. 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. 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. 

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