Didier Blaise教授分享预处理方案对老年患者移植成功的影响

2024年11月14日至17日，国际细胞与免疫治疗（CTI）大会在中国杭州盛大举行，汇聚了全球细胞治疗和免疫治疗领域的顶尖专家、学者和行业领袖。此次大会不仅是一个学术交流的国际平台，更是一个展示最新科研成果、推动领域发展的重要窗口。此次会议，法国马赛大学血液学研究所Didier Blaise教授带来了题为《The lmpact of the Conditioning Regimen on the Success of Transplantation in Aged Patients》的演讲，《肿瘤瞭望-血液时讯》特邀Didier Blaise教授，为我们分享了他对平衡预处理方案强度与并发症风险的见解，还探讨了预处理方案优化对老年患者长期生存率和生活质量的影响，以及未来预处理方案可能面临的新趋势和挑战。

Q1

我们知道，预处理方案可能会影响移植后的并发症发生率。在您看来，对于老年患者，如何平衡预处理方案的强度与减少并发症风险之间的关系？

Didier Blaise教授：在移植领域，预处理方案的强度与患者移植后的并发症风险之间存在着微妙的平衡。这一点在老年患者中尤为关键，因为他们的恢复能力通常不如年轻患者。多年来，我们一直在努力实现这一平衡，这是移植历史上的一个长期挑战。

目前，我们面临的主要任务是降低预处理方案的毒性，同时保持其对疾病治疗的有效性。为此，我们已经在降低强度的预处理方案方面取得了进展。这种方案旨在减少细胞毒性，从而降低移植相关的毒性，但同时也带来了对移植效果可能减弱的风险。

为了解决这一问题，我们已经开展了大量的研究工作，以寻找最佳的治疗方案。我们的目标是为每位患者找到个性化的最佳平衡点，既能有效控制疾病，又能最大限度地减少并发症的风险。虽然这是一个复杂的过程，需要综合考虑患者的年龄、健康状况、疾病特点等多种因素，但随着我们对移植医学的深入了解和临床经验的积累，我们有信心能够逐步找到适合老年患者的最优预处理方案。

Oncology Frontier-Hematology Frontier：It is known that conditioning regimens can affect the incidence of post-transplantation complications. In your opinion, how can we balance the intensity of conditioning regimens and the risk of reducing complications for elderly patients?

Professor Didier Blaise：In fact, this is a goal that we have been striving to achieve for many years, since the beginning of the history of transplantation. As you mentioned, it is even more crucial now because we are treating older patients. There is no choice but to decrease the toxicity of the conditioning regimen, which is very important. Much work has been done in this area, notably by using reduced-intensity conditioning regimens. What we know at present is that the cytotoxicity of the conditioning regimen creates the toxicity of the transplantation.

However, and it's part of the question. You ask whether we decrease the intensity of the conditioning regimen, you decrease the potent the value of the cytotoxicity of the transplantation against the disease. So that's very important to find these good balance and many works are done on that but for sure we will find progressively the optimal balance for each patient we want to treat.

Q2

预处理方案的优化对老年患者移植后的长期生存率和生活质量有何影响？您能否分享一些您在这方面的研究成果或观察？

Didier Blaise教授：预处理方案的优化至关重要。当我们在谈论移植时，我们谈论的是长期生存和生活质量。老年患者因其基础疾病和合并症较多、生物学特征差异较大、体能状态和耐受性较差，其移植后的长期生存和生活质量更是直接关系到移植的最终成效。但同时，我们必须认识到，虽然预处理方案对于确保移植物功能和控制疾病进展至关重要，但它并不是影响患者长期预后的唯一因素。实际上，移植后的治疗同样扮演着重要角色，特别是在提升患者的生活质量方面。通过降低移植初期的毒性，我们可以显著改善患者的生活质量。作为移植医疗团队的一部分，我们有责任确保患者在移植后能够得到全面的护理，以改善他们的生活质量。我们的研究成果和临床实践表明，通过综合考虑预处理方案和移植后治疗，我们可以为老年患者提供更安全、更有效的移植治疗方案。

Oncology Frontier-Hematology Frontier：What is the impact of optimized conditioning regimens on the long-term survival rate and quality of life of elderly patients after transplantation? Could you share some of your research findings or observations in this regard?

Professor Didier Blaise：Your question is very important because when we talk about transplantation nowadays, we talk about long-term outcomes and quality of life, which is very important for the surviving patients. Coming back to the first question and your current question, I don't think we should focus only on the conditioning regimen, where conditioning is really pivotal for a successful transplantation in terms of graft function and disease control.

However, it is not the only tool we can use, and notably, we can use post-transplant treatments, which are very important in terms of quality of life. If we decrease the toxicity of the initial part of transplantation, we will increase the quality of life. It is part of the duties of those doing transplantation to take care of this aspect as well, and it is very important. We have increased the quality of life of patients.

Q3

随着医学的进步，预处理方案也在不断发展和创新。您认为未来预处理方案在老年患者移植领域会有哪些新的发展趋势或挑战？

Didier Blaise教授：我必须再次强调，仅仅关注预处理方案并不是一个全面的策略。我们应该将移植视为一个整体过程，其中预处理方案扮演着至关重要的角色。预处理方案的目的是为了确保患者的生命安全，提供有效的疾病控制，并维持良好的生活质量。

在这一策略的指导下，我们的目标是实现患者的最佳治疗效果。为此，我们不仅要关注移植后的管理，还要重视移植前的工作。通过在不同阶段分散治疗的强度，我们可以减轻患者的负担，提高治疗效果。我认为，这种综合考虑移植前后工作的方法，不仅适用于当前的临床实践，也将是未来发展的趋势。

Oncology Frontier-Hematology Frontier：With the advancement of medical science, conditioning regimens are constantly evolving and innovating. What do you think will be the new trends or challenges in the field of conditioning regimens for elderly patients in the future?

Professor Didier Blaise：Once again, I do think that focusing solely on the conditioning regimen is not a good strategy. We must really envision transplantation as a whole, where the conditioning regimen is pivotal. However, we have come to construct this strategy to ensure that we keep the patient alive, provide good disease control, and a good quality of life. What we do afterward is very important, and I will add that probably what we do before transplantation is very important in order to distribute the intensity of the anti-cancer treatment in different phases. And I think this is already what we do now, but it will also be the case in the future.

Didier Blaise 教授

国际著名造血干细胞移植和细胞免疫治疗专家

法国马赛大学血液学研究所

Paoli Calmettes学院血液和骨髓移植和细胞治疗项目主任

血液病科医疗主任

欧洲肿瘤内科学会（ESMO）与欧洲血液学会（EHA） 会员