[The Foundation of Allogeneic Hematopoietic Stem Cell Transplantation and the Role of Clinical Laboratory Tests in This Field].

Mika Nakamae
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Abstract

Despite the marked progress in the procedure of allogeneic hematopoietic stem cell transplantation (allo- HCT) as a curative therapy for hematological malignancy, we still need to resolve issues in clinical laboratory testing for the assessment of transplant patients. For example, minimal residual disease (MRD) negativity before transplantation is known to be associated with good survival, but the widespread use of the multi-color flow cytometry system is needed for the routine assessment of MRD. In addition, we should apply an appropriate testing system for counting harvested bone marrow cells with careful consideration of the meas- urement principle of testing equipment because bone marrow is different from peripheral blood in its compo- sition of cells and components. It is also a problem that the short tandem repeat-polymerase chain reaction (PCR) for the evaluation of donor chimerism is not covered by Japanese national health insurance. Tissue biopsy is useful for the diagnosis of graft-versus-host disease, transplantation-associated microangi- opathy, and sinusoidal obstruction syndrome. It is, however, potentially dangerous for patients who have thrombocytopenia after allo-HCT to undergo a biopsy. Non-invasive tests including surrogate makers for the diagnosis of those complications are highly desirable, but they have been not established. Moreover, limitations in the diagnosis of infection after allo-HCT by laboratory tests include the poor clinical utility of the viral antibody test after allo-HCT and the fact that quantitative virus PCR tests after allo-HCT are not covered by Japanesehational health insurance. The number of long-term transplant survivors has increased in recent years. We therefore need to focus on treatment strategies against long-term complications after allo-HCT and the improvement of the quality of life. Further progress in laboratory medicine in the allo-HCT field may contribute to the prevention of late complications and/or improvement of the quality of life. I.

异体造血干细胞移植的基础及临床实验室检测在该领域的作用
尽管同种异体造血干细胞移植(allogeneic hematopoietic stem cell transplantation, allo- HCT)作为一种治疗恶性血液病的治疗方法取得了显著进展,但我们仍然需要解决临床实验室检测中对移植患者进行评估的问题。例如,已知移植前最小残留病(MRD)阴性与良好的生存率相关,但需要广泛使用多色流式细胞术系统进行MRD的常规评估。此外,由于骨髓与外周血的细胞组成和成分不同,我们应采用适当的检测系统对采集的骨髓细胞进行计数,并仔细考虑检测设备的测量原理。另外一个问题是,用于评估供体嵌合的短串联重复聚合酶链反应(PCR)不包括在日本国民健康保险范围内。组织活检对移植物抗宿主病、移植相关微血管病变和窦状动脉阻塞综合征的诊断是有用的。然而,对于同种异体hct后患有血小板减少症的患者进行活检是有潜在危险的。诊断这些并发症的非侵入性测试,包括替代制造商,是非常可取的,但它们尚未建立。此外,通过实验室检测诊断同种异体hct后感染的局限性包括同种异体hct后病毒抗体检测的临床实用性较差,以及同种异体hct后定量病毒PCR检测不包括在日本国民健康保险范围内。近年来,长期移植幸存者的数量有所增加。因此,我们需要把重点放在治疗策略上,以防止抗逆转录病毒移植后的长期并发症和改善生活质量。allo-HCT领域检验医学的进一步进展可能有助于预防晚期并发症和/或改善生活质量。我。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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