Didier Blaise教授：老年患者异基因造血干细胞移植策略优化

编者按：老年患者通常伴随多种合并症及体能虚弱，这使得异基因造血干细胞移植在该群体中的应用面临显著挑战。因此，如何优化治疗方案以满足老年患者的特殊需求，成为当前医学研究中的关键课题。在近日召开的中国临床肿瘤学会（CSCO）第九届血液肿瘤学术大会上，法国马赛保利·卡尔梅特研究所Didier Blaise教授就“Advancing Allogeneic HSCT in Older Patients”（老年患者异基因造血干细胞移植进展）作了精彩演讲，并在接受采访时深入探讨了该领域面临的挑战及创新解决方案。

《肿瘤瞭望-血液时讯》：随着全球人口老龄化，老年患者接受异基因造血干细胞移植的需求增加。您认为当前这一领域面临的最大挑战是什么？

Didier Blaise教授：对于老年患者，必须准确评估其病情，并根据患者的具体状况调整治疗方案。如果患者因体弱而不适合进行移植治疗，其他替代治疗方案可以作为选择。然而，若患者因缺乏其他治疗选择而面临死亡风险，则必须进行更为精确的临床评估，并在此基础上调整治疗流程，以最大限度地提高治疗效果。

如前所述，应根据不同患者群体的需求对标准移植流程进行必要的调整。这些调整不仅包括治疗剂量的优化，还需充分考虑各类支持性治疗措施，如物理治疗和心理健康支持等。这些关键性因素的综合应用对于老年体弱患者群体的治疗成功至关重要。

Oncology Frontier-Hematology Frontier：With the global aging population, the demand for allogeneic hematopoietic stem cell transplantation (HSCT) in older patients is increasing. What do you consider the biggest challenge in this field today?

Professor Didier Blaise：For frail patients, it is essential to accurately assess their condition and adjust the treatment plan accordingly. One possible approach may be to refrain from performing a transplant if the patient is frail. However, if it is determined that the patient faces a risk of death due to the absence of alternative treatment options, a precise evaluation of the patient’s condition is necessary, followed by appropriate modifications to the treatment protocol.

As mentioned, the standard transplant process must be adapted to meet the specific needs of different patient populations. These adjustments should encompass not only the intensity of treatment doses but also various aspects of supportive care, such as physical therapy and mental health support. The integration of these critical factors is paramount to ensuring successful transplantation, particularly in the frail elderly patient cohort.

《肿瘤瞭望-血液时讯》：在老年患者群体中，异基因造血干细胞移植的成功率与并发症管理与年轻患者相比有何不同？您认为哪些关键因素能够显著提高老年患者的移植成功率？

Didier Blaise教授：老年患者通常表现为虚弱，这是由多种因素综合作用的结果，包括合并症、功能衰退以及年龄的增长。这些因素共同决定了患者的虚弱程度，因此需要对每位患者的虚弱状态进行个体化的评估。评估结果应作为调整治疗方案的依据，以确保治疗的针对性和有效性。

在这种情况下，支持性护理的作用尤为重要，支持性护理不仅局限于常规的抗生素或药物治疗，更应涵盖心理健康、物理治疗和营养干预等方面。所有这些因素对老年患者的治疗至关重要，而对于年轻患者而言，这些因素的影响相对较小，尽管它们在治疗过程中依然可能发挥一定作用。

Oncology Frontier-Hematology Frontier：In older patient populations, how does the success rate and management of complications in allogeneic HSCT differ from younger patients? What key factors do you think are critical in improving transplant success in elderly patients?

Professor Didier Blaise：Elderly patients are often characterized by frailty, which results from a combination of factors such as comorbidities, functional decline, and aging. These factors collectively influence the degree of frailty in each patient, necessitating an individualized assessment of frailty status. The assessment results should guide the adjustment of treatment plans to ensure that they are targeted and effective.

In this context, the role of supportive care becomes critical. Supportive care extends beyond the routine use of antibiotics or medications and includes elements such as mental health support, physical therapy, and nutritional interventions. These factors are crucial for the treatment of elderly patients, whereas, for younger patients, their importance is relatively lower, although they still contribute to treatment outcomes.

《肿瘤瞭望-血液时讯》：随着移植技术和支持治疗的进步，老年患者的治疗策略是否发生了变化？您认为哪些创新或策略最能改善老年患者的治疗预后？

Didier Blaise教授：回顾三四十年前，患者的中位年龄通常低于40岁，而现如今，在我们的项目中，患者的年龄范围已从61、62岁扩展至80岁。这一变化对治疗带来了显著的挑战。为应对这一变化，我们已采取减低预处理强度的措施。然而，尽管治疗强度有所调整，我们依然明确认识到，病情的控制未能达到以往的效果。因此，移植后的各个治疗阶段尤为关键。在这些阶段中，靶向治疗、免疫治疗以及维持治疗等治疗方案的应用将成为治疗成功的关键因素。这些治疗策略的引入，将显著改变老年患者异基因造血干细胞移植治疗的格局。

Oncology Frontier-Hematology Frontier：With the advancements in transplant techniques and supportive care, have the treatment strategies for older patients changed? What innovations or strategies do you believe are most impactful in improving the prognosis for elderly patients?

Professor Didier Blaise：Clearly, innovation is crucial in this context. Looking back 30 or 40 years ago, the median age of patients was under 40, whereas now, in our program, the patient age range extends from 61-62 to 80 years old. This change has brought about many new challenges and opportunities. To adapt to this, we have reduced the intensity of the conditioning regimen. However, we are well aware that, despite this adjustment, disease control is not as effective as it was before. Therefore, all the phases after transplantation become crucial. During these phases, we can administer other forms of treatment, such as targeted therapy, immunotherapy, or maintenance therapy. These parameters are vital and have significantly changed the landscape of allogeneic transplantation.

总 结

老年患者在接受异基因造血干细胞移植时，面临着诸多挑战。如何在确保患者生命质量的同时，优化治疗方案，成为临床实践中的关键问题。Didier Blaise教授在此次大会上的精彩演讲和深入的见解，为我们提供了重要的指导。特别是针对老年患者的虚弱状态，个体化评估和治疗方案的调整显得尤为重要。此外，创新治疗策略的引入，如靶向治疗、免疫治疗和维持治疗，为老年患者群体提供了更多治疗选择，并显著提升了移植的成功率和患者的长期生存率。未来，如何进一步整合这些治疗策略并优化支持性护理，将是提高老年患者移植效果的关键。

Didier Blaise教授

法国马赛保利·卡尔梅特研究所

法国马赛保利·卡尔梅特(Paoli-Calmettes)研究所血液与骨髓移植及细胞治疗项目负责人

法国艾克斯-马赛大学医学院教授

法国骨髓移植与细胞治疗学会（SFGM-TC）的创始成员、前任主席

在多个国际血液学与干细胞移植专业学会及顾问委员会中任职

已发表 400 余篇同行评议论文，主持多项国家级科研基金

研究方向为临床移植、异基因干细胞移植后的免疫调节、血液系统恶性肿瘤及实体肿瘤的免疫治疗，以及异基因干细胞移植的经济与社会影响