Các dấu ấn sinh học cho kết quả sau ghép tế bào gốc huyết học

Blood - Tập 131 - Trang 2193-2204 - 2018
Sophie Paczesny1
1Department of Pediatrics, Department of Microbiology Immunology, and Melvin and Bren Simon Cancer Center, School of Medicine, Indiana University, Indianapolis, IN

Tóm tắt

Tóm tắtTrong thập niên qua, sự phát triển của các dấu ấn sinh học cho các biến chứng xảy ra sau khi ghép tế bào gốc huyết học đồng loài đã mở rộng một cách lớn lao, với những tiến bộ nhất định được ghi nhận cho bệnh ghép đối kháng chủ yếu cấp tính (aGVHD), một biến chứng phổ biến và thường dẫn đến tử vong. Mặc dù đã có nhiều yếu tố được biết đến ảnh hưởng đến kết quả ghép (bao gồm độ tuổi của người nhận, tình trạng bệnh đi kèm, cường độ điều trị chuẩn bị, nguồn gốc người hiến, sự tương thích HLA của người hiến và người nhận, phác đồ điều trị chuẩn bị, và phòng ngừa aGVHD sau ghép), nhưng chúng vẫn chưa đủ để dự đoán kết quả. Nhờ vào những tiến bộ trong công nghệ genomics, transcriptomics, proteomics, và cytomics, các dấu ấn sinh học trong máu đã được xác định và hợp lệ hóa để sử dụng trong các thử nghiệm chẩn đoán đầy hứa hẹn, các thử nghiệm tiên đoán phân tầng cho khả năng xảy ra aGVHD trong tương lai, và các thử nghiệm dự đoán đáp ứng với phương pháp điều trị aGVHD cũng như tỷ lệ tử vong không tái phát. Những dấu ấn sinh học này có thể giúp can thiệp điều trị một cách kịp thời và có chọn lọc. Tuy nhiên, các xét nghiệm máu như vậy vẫn chưa có sẵn cho việc chăm sóc lâm sàng thường quy. Bài báo này cung cấp một cái nhìn tổng quan về các dấu ấn sinh học tiềm năng cho đánh giá lâm sàng và phác thảo một lộ trình từ phát hiện dấu ấn sinh học đến tương quan lâm sàng đầu tiên, đến việc hợp lệ hóa trong các nhóm độc lập, đến thử nghiệm lâm sàng dựa trên dấu ấn sinh học, và cuối cùng là ứng dụng lâm sàng chung. Bài báo này tập trung vào các dấu ấn sinh học được phát hiện thông qua nền tảng proteomics quy mô lớn và đã được hợp lệ hóa với cùng một phương pháp lặp lại trong ít nhất 2 nhóm độc lập có kích thước mẫu đủ theo tiêu chí đồng thuận về dấu ấn sinh học của Viện Y tế Quốc gia Hoa Kỳ năm 2014, cũng như về các dấu ấn sinh học như là các xét nghiệm phân tầng rủi ro cho kết quả, nhưng không tập trung vào các đóng góp về bệnh sinh của chúng, đã được xem xét gần đây.

Từ khóa


Tài liệu tham khảo

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