在新兴国家,获得性再生障碍性贫血(AA)的管理取决于预后分层的方法,治疗和后勤可用。在法语国家骨髓移植和细胞治疗协会(SFGM-TC)的第13届年度协调研讨会上,一个指定的工作组回顾了文献,以便详细阐述针对该疾病的异基因造血细胞移植(Allo-HCT)的统一指南.在实践方面,结论如下:抗瘤细胞球蛋白(ATG)的使用主要来自兔,很少来自马。获得骨髓移植,全身照射,国际无关的捐助者登记册是有限的,这证明了使用外周血干细胞的合理性,基于化疗的调理,和相关的替代捐赠者。研讨会建议在所有年龄小于40岁的患有严重或非常严重AA的患者中进行匹配的同胞allo-HCT。对于40岁以上的患者,或者缺乏HLA相同的捐赠者,用环孢菌素联合治疗,马ATG,eltrombopag或环孢菌素,建议使用eltrombopag。如果马ATG和eltrombopag不可用,匹配的同胞allo-HCT可以作为40-60岁患者的一线治疗,和良好的性能状态。虽然,在免疫抑制治疗和血小板生成素激动剂失败的患者中,在没有HLA匹配供体的情况下,建议使用具有改良的巴尔的摩空调的haplo相同的allo-HCT。
Management of acquired aplastic anemia (AA) in emerging countries depends on the means of prognostic stratification, treatment and logistics available. During the 13th annual harmonization workshop of the francophone Society of bone marrow transplantation and cellular therapy (SFGM-TC), a designated working group reviewed the literature in order to elaborate unified guidelines for allogeneic hematopoietic cell transplantation (Allo-HCT) in this disease. In terms of practice, the conclusions are as follows; The use of anti-tymocyte globuline (ATG) is mainly from rabbit and very little from horse. Access to bone marrow graft, total body irradiation, and the international unrelated donor registries is limited, which justifies the use of peripheral blood stem cells, chemotherapy-based conditioning, and related alternative donor. The workshop recommends matched sibling allo-HCT in all patients aged less than 40 years with acquired severe or very severe AA. For patients aged over than 40 years, or who lack an HLA-identical donor, treatment with the combination of cyclosporin, horse ATG, eltrombopag or cyclosporine, eltrombopag is recommended. If horse ATG and eltrombopag are not available, matched sibling allo-HCT may be indicated as first-line therapy in patients aged between 40-60 years, and good performance status. Although, in patients who have failed immunosuppressive treatments and thrombopoietin agonists, and in the absence of HLA-matched donor, a haplo-identical allo-HCT with modified Baltimore conditioning is recommended.