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首页> 外文期刊>Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation >National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report
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National Institutes of Health Hematopoietic Cell Transplantation Late Effects Initiative: The Subsequent Neoplasms Working Group Report

机译：国家健康造血细胞移植后期效应倡议：随后的肿瘤工作组报告

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Subsequent neoplasms (SN) after hematopoietic cell transplantation (HCT) cause significant patient morbidity and mortality. Risks for specific SN types vary substantially, with particularly elevated risks for post transplantation lymphoproliferative disorders, myelodysplastic syndrome/acute myeloid leukemia, and squamous cell malignancies. This document provides an overview of the current state of knowledge regarding SN after HCT and recommends priorities and approaches to overcome challenges and gaps in understanding. Numerous factors have been suggested to affect risk, including patient-related (eg, age), primary disease-related (eg, disease type, pre-HCT therapies), and HCT-related characteristics (eg, type and intensity of conditioning regimen, stem cell source, development of graft-versus-host disease). However, gaps in understanding remain for each of these risk factors, particularly for patients receiving HCT in the current era because of substantial advances in clinical transplantation practices. Additionally, the influence of nontransplantation-related risk factors (eg, germline genetic susceptibility, oncogenic viruses, lifestyle factors) is poorly understood. Clarification of the magnitude of SN risks and identification of etiologic factors will require large-scale, long-term, systematic follow-up of HCT survivors with detailed clinical data. Most investigations of the mechanisms of SN pathogenesis after HCT have focused on immune drivers. Expansion of our understanding in this area will require interdisciplinary laboratory collaborations utilizing measures of immune function and availability of archival tissue from SN diagnoses. Consensus based recommendations for optimal preventive, screening, and therapeutic approaches have been developed for certain SN after HCT, whereas for other SN, general population guidelines are recommended. Further evidence is needed to specifically tailor preventive, screening, and therapeutic guidelines for SN after HCT, particularly for unique patient populations. Accomplishment of this broad research agenda will require increased investment in systematic data collection with engagement from patients, clinicians, and interdisciplinary scientists to reduce the burden of SN in the rapidly growing population of HCT survivors. Published by Elsevier Inc. on behalf of the American Society for Blood and Marrow Transplantation.
机译：造血细胞移植（HCT）后随后的肿瘤（SN）引起显着的患者发病率和死亡率。特定SN类型的风险显着变化，后移植后淋巴抑制性疾病，髓细胞增生综合征/急性髓性白血病以及鳞状细胞恶性肿瘤的风险特别高。本文件概述了关于HCT之后关于SN的当前知识状态，并建议克服挑战和理解差距的优先事项和方法。已经提出了许多因素来影响风险，包括与患者相关的（例如，年龄），有关（例如，疾病类型，HCT疗法）和HCT相关特征（例如，调理方案的类型和强度，干细胞源，嫁接腹膜疾病的发展）。然而，由于临床移植实践的实质性进展，对每个风险因素进行了解中的每个风险因素，特别是在当前时代接受HCT的患者留下的差距。另外，非传播相关的风险因素（例如，种系遗传易感性，致癌病毒，生活方式因子）的影响很差。澄清SN风险的幅度和病因因子的鉴定将需要大规模，长期，系统的HCT幸存者的系统随访，具有详细的临床数据。 HCT后Sn发病机制的大多数研究都集中在免疫司机上。我们在该领域的理解扩张将需要利用免疫功能的措施和来自SN诊断的档案组织的可用性的跨学科实验室合作。在HCT之后的某些SN开发了基于最佳预防，筛选和治疗方法的基于建议，而对于其他SN，建议使用一般人群指南。需要进一步的证据来特异性地定制HCT后SN的预防，筛选和治疗指南，特别是对于独特的患者群体。这一广泛的研究议程的实现将需要增加系统数据收集的投资，并从患者，临床医生和跨学科科学家参与，以减少迅速增长的HCT幸存者人口中SN的负担。由elsevier公司发布代表美国血液和骨髓移植社会。

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