Adult patients affected by acute myeloid leukemia who fail to achieve remission after two cycles of intensive chemotherapy based on a combination of anthracyclines and cytarabine are considered chemorefractory and are unlikely to benefit from further induction attempts. Characterized by a poor prognosis, they may still benefit from allogeneic hematopoietic stem cell transplantation, even if long-term survival rarely exceeds 20–30%. Still, the use of sequential high-dose chemotherapy followed by reduced-intensity conditioning, with transplantation performed during aplasia, and the optimization of the alloreactivity of donor leukocytes against leukemia (i.e., the graft-versus-leukemia effect) may ameliorate these results. Optimization of alloreactivity against leukemic cells can be achieved by proper donor selection, by the early withdrawal of immunosuppressive therapy, by post-transplant administration of donor lymphocyte infusions as prophylaxis of leukemia relapse, and by several other maintenance and preemptive therapies. Far from being the final stage of consolidation therapy, allogeneic hematopoietic stem cell transplantation is now considered as the moment when a unique immunological platform can be established in these patients, to be used for additional post-transplant measures. In this study we will critically review the different pre- and post-transplant strategies used in clinical trials to improve long-term survival in adult patients transplanted with chemorefractory leukemia.
患有急性髓系白血病的成年患者，在接受基于蒽环类药物与阿糖胞苷联合的强化化疗两个周期后，若未能达到缓解，则被视为化疗难治性病例，且不太可能从进一步的诱导治疗中获益。这类患者预后较差，但仍可能受益于异基因造血干细胞移植，尽管其长期生存率很少超过20%-30%。然而，通过序贯高剂量化疗联合减低强度预处理方案（在骨髓抑制期进行移植），并优化供体白细胞对白血病细胞的同种异体反应（即移植物抗白血病效应），可能改善这些结果。针对白血病细胞的同种异体反应优化可通过以下方式实现：选择合适的供体、早期撤除免疫抑制治疗、移植后输注供体淋巴细胞以预防白血病复发，以及采用其他多种维持治疗和先发干预疗法。异基因造血干细胞移植已远非巩固治疗的终末阶段，目前被视为在这些患者中建立独特免疫平台的契机，该平台可用于实施移植后的附加干预措施。本研究将批判性回顾临床试验中采用的不同移植前及移植后策略，旨在改善化疗难治性白血病成年移植患者的长期生存。
肿瘤(癌症)患者之家