Abstract:
The consensus recommendations in 2018 from The Chinese Society of Hematology (CSH) on indications, conditioning regimens and donor selection for allogeneic hematopoietic stem cell transplantation (allo-HSCT) facilitated the standardization of clinical practices of allo-HSCT in China and progressive integration with the world. There have been new developments since the initial publication. To integrate recent developments and further improve the consensus, a panel of experts from the CSH recently updated the consensus recommendations, which are summarized as follows: (1) there is a new algorithm for selecting appropriate donors for allo-HSCT candidates. Haploidentical donors (HIDs) are the preferred donor choice over matched sibling donors (MSDs) for patients with high-risk leukemia or elderly patients with young offspring donors in experienced centers. This replaces the previous algorithm for donor selection, which favored MSDs over HIDs. (2) Patients with refractory/relapsed lymphoblastic malignancies are now encouraged to undergo salvage treatment with novel immunotherapies prior to HSCT. (3) The consensus has been updated to reflect additional evidence for the application of allo-HSCT in specific groups of patients with hematological malignancies (intermediate-risk acute myeloid leukemia (AML), favorable-risk AML with positive minimal residual disease, and standard-risk acute lymphoblastic leukemia). (4) The consensus has been updated to reflect additional evidence for the application of HSCT in patients with nonmalignant diseases, such as severe aplastic anemia and inherited diseases. (5) The consensus has been updated to reflect additional evidence for the administration of anti-thymocyte globulin, granulocyte colony-stimulating factors and post-transplantation cyclophosphamide in HID-HSCT.
摘要:
2018年中国血液学会(CSH)关于适应症的共识建议,异基因造血干细胞移植(allo-HSCT)的预处理方案和供体选择促进了中国allo-HSCT临床实践的标准化和与世界的逐步融合。自首次出版以来,有了新的发展。整合最近的事态发展,进一步完善共识,CSH的专家小组最近更新了共识建议,其总结如下:(1)有一种新的算法用于为allo-HSCT候选物选择合适的供体。对于高风险白血病患者或在经验丰富的中心有年轻后代供体的老年患者,单倍体供体(HID)是比匹配的同胞供体(MSD)的首选供体选择。这取代了以前的捐赠者选择算法,它偏爱MSD而不是HID。(2)现在鼓励患有难治性/复发性淋巴母细胞恶性肿瘤的患者在HSCT之前接受新型免疫疗法的抢救治疗。(3)共识已更新,以反映将allo-HSCT应用于血液系统恶性肿瘤(中危急性髓细胞性白血病(AML),具有阳性微小残留病的有利风险AML,和标准风险急性淋巴细胞白血病)。(4)共识已更新,以反映在非恶性疾病患者中应用HSCT的其他证据,如严重的再生障碍性贫血和遗传性疾病。(5)共识已更新,以反映抗胸腺细胞球蛋白给药的其他证据,HID-HSCT中粒细胞集落刺激因子和移植后环磷酰胺。