Journal of Clinical Pediatrics ›› 2023, Vol. 41 ›› Issue (3): 181-186.doi: 10.12372/jcp.2022.22e1691
• Expert Review • Previous Articles Next Articles
FANG Yongjun, WEI Yuting, XUE Yao
Received:2022-12-20
Published:2023-03-15
Online:2023-03-10
FANG Yongjun, WEI Yuting, XUE Yao. Advance in lysosomal storage disorders treated with allogeneic hematopoietic stem cell transplantation[J].Journal of Clinical Pediatrics, 2023, 41(3): 181-186.
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| LSD | 药物治疗 方案 | allo-HSCT | ||||
|---|---|---|---|---|---|---|
| 适应证 | 移植时机 | 供体选择 | 预处理方案 | 潜在不良事件 | ||
| 黏多糖贮积症 | ERT、基因治疗、药物伴侣、减少底物 | 绝对适应证:年龄<2.5岁的MPSI重型(MPS IH)患者 相对适应证:年龄>2.5岁的MPS IH型患者,MPS Ⅰ非重型、MPS Ⅱ、Ⅳ、Ⅵ、Ⅶ型患者 | 尽早移植,移植年龄小于2周岁为佳 | 首选非携带、同胞全相供者,次选非亲缘脐血 | 清髓性方案(BuCy,联合或不联合ATG) | 植入失败、移植相关并发症,无法改善移植前形成的病变,对合并神经受损患者疗效欠佳 |
| 戈谢病 | ERT、基因治疗、药物伴侣、减少底物 | Ⅰ型儿童期发病者为最佳适应证,对于Ⅱ型和Ⅲ型患者,建议在神经症状出现前行HSCT | 尽早移植,明显肝功和神经受损等症状出现前 | 首选非携带、同胞全相供者,次选非亲缘脐血 | 清髓性方案(BuCy,联合或不联合ATG) | GVHD、感染、植入失败或死亡等移植后相关并发症 |
| 尼曼-匹克病 | ERT、基因治疗、减少底物 | 无绝对适应证,无神经系统受损或早期症状者可考虑行HSCT | 尽早移植,建议未出现神经系统改变前行HSCT | 首选无携带、HLA全相合同供者,次选优非亲缘脐血 | 清髓性方案(BuCy,联合或不联合ATG) | 疗效个体差异性大,风险较大,改善神经系统受损症状的效果及预后不确定 |
| 异染性脑白质营养不良 | ERT、基因治疗 | 部分无症状晚婴型、轻微早期症状的青少年或成人型MLD | 早期移植,建议症状发生前进行 | 首选未携带变异、HLA全相合同供者,次优选非亲缘脐血 | 清髓性方案(BuCy,联合或不联合ATG) | 移植相关病死率较高,无法改善周围神经系统受累 |
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