[移植后并发症:GVHD和SOS/VOD]。

Yasuo Mori
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引用次数: 0

摘要

几种新型药物(如分子靶向药物、双特异性抗体、抗体-药物偶联物、嵌合抗原受体t细胞疗法)相继出现在临床实践中,偶尔用于异体造血细胞移植(alloo - hct)。这些药物有望减少移植前肿瘤,降低移植后维持治疗的复发风险,从而改善移植结果。此外,一些分子靶向药物可以适用于治疗类固醇难治性急性和/或慢性移植物抗宿主病(GVHD),这仍然是同种异体移植后非复发死亡率的主要原因。然而,这些药物会产生过度的免疫反应,包括GVHD,或者由于其“脱靶”效应而增加了窦状静脉阻塞综合征(SOS)/静脉闭塞性疾病(VOD)的风险。因此,本文旨在总结分子靶向治疗时代移植后并发症的风险评估和处理,重点是GVHD和SOS/VOD。此外,还讨论了使用新型药物/设备预防和治疗GVHD或SOS/VOD的最新进展。
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[Posttransplant complications: GVHD and SOS/VOD].

Several novel agents (e.g., molecularly targeted drug, bispecific antibody, antibody-drug conjugate, chimeric antigen receptor T-cell therapy) have successively emerged in clinical practice and are occasionally used in allogeneic hematopoietic cell transplantation (allo-HCT) settings. These drugs are expected to reduce pretransplant tumors, lower the risk of relapse with posttransplant maintenance therapy, and consequently improve transplant outcomes. Additionally, some molecularly targeted drugs could be adapted to treat steroid-refractory acute and/or chronic graft-versus-host disease (GVHD), which remained the leading cause of nonrelapse mortality after allo-HCT. However, these agents develop an excessive immune reaction, including GVHD, or presented an increased risk of sinusoidal obstruction syndrome (SOS)/veno-occlusive disease (VOD) as their "off-target" effects. Thus, this review aimed to summarize the risk assessment and management of post-posttransplant complications, focusing on GVHD and SOS/VOD, in the era of molecularly targeted therapy. Moreover, recent advances in GVHD or SOS/VOD prophylaxis and treatment using novel agents/devices are also discussed.

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