Treatment of acute myeloid leukemia with hematopoietic stem cell transplantation

Akutna mieloična levkemija (AML) je maligna bolezen, ki nastane kot posledica mutacij in sproži nenadzorovano rast multipotentnih krvotvornih matičnih celic, ki izgubijo sposobnost diferenciacije. Ker je potek bolezni zelo hiter, zahteva takojšnje zdravljenje. AML navadno zdravimo z intenzivno kemoterapijo, ki ji sledi presaditev krvotvornih matičnih celic. Najbolj razširjen tip presaditve predstavlja alogenična presaditev KMC. Zaradi visoke smrtnosti in hitrega poslabšanja bolezni, bi morali to terapijo uporabiti predvsem pri bolnikih z visoko stopnjo tveganja ponovitve bolezni. Alogenična presaditev KMC in terapija s CAR-T sta dve glavni celični imunoterapiji, ki se uporabljata v klinični praksi. Celična terapija lahko sproži imunski odziv bolnikov in možne zaplete po presaditvi. Velik problem predstavlja neskladje v HLA antigenih, ki lahko povzročajo akutno in/ali kronično bolezen presadka proti gostitelju ali pa zavrnitev presadka. Darovalca KMC sprva iščemo v družini. Če ne najdemo skladnega darovalca, iščemo naprej v registru prostovoljnih darovalcev. Zadnje študije so dokazale, da so primerni darovalci KMC tudi nesorodni haploidnetični darovalci, saj so rezultati transplantacij primerljivi z ujemajoči sorodnimi darovalci. Tudi uporaba mezenhimskih matičnih celice (MSC) in induciranih pluripotentnih matičnih celice (iPSC) obetata napredek pri celičnih terapijah za AML.Acute myeloid leukaemia (AML) is a malignant disorder characterized by abnormal growth and differentiation of haematopoietic stem cells (HSCs), in which immature myeloid precursors (myeloblasts) accumulate in the bone marrow and peripheral blood. Due to its rapid progress it requires immediate treatment. AML treatment usually begins with intense chemotherapy, followed by hematopoietic stem cell transplantation. Allogeneic HSCT provides the most powerful antileukemic effect in the treatment of AML. Due to its significant mortality and rapid progress it should be used in first remission patients with high relapse rates. Although allotransplantation is the only curative treatment available for patients with advanced disease, the chances for remission are low. Cell therapies can lead to strong immune response and possible post-transplant complications. Reduced HLA matching between recipient and donor increases the risks of graft rejection and graft versus host disease (GvHD). An HLA identical or fully HLA matched sibling is considered the optimal and first choice graft for allogeneic HCT. If that\u27s not possible, they start searching for it in large international volunteer donor registries. Recent studies have documented that the haploidentical donors are also a possible solution, as they give comparable results as fully-matched donors. Mesenchymal stem cells and induced pluripotent stem cells are promising therapeutic targets for future directions in transplantation of stem cells