Zusammenfassung
Gemäß einem Modell nach Balducci verschiebt sich die Stammzellreserve im Alter vom „ruhenden“, selbstreproduzierenden Pool zum proliferierenden Pool, entsprechend den höheren Anforderungen zur Gewährleistung der immunologischen Homöostase und Infektabwehr. „Hämatopoetischer Stress“ jeder Art, z. B. bei einer Sepsis oder einer zytoreduktiven Chemotherapie, führt zu einer Verminderung der peripheren Stammzellzahl bei Älteren im Gegensatz zu einem Anstieg bei Jüngeren. Diese Veränderungen sind etwa ab dem 70. Lebensjahr physiologisch relevant. Zusätzlich kommt es auch zu einer Änderung der Granulozytenfunktion, speziell ihrer phagozytären Kapazität, sowie der Balance zwischen stimulierenden und hemmenden Zytokinen. Bestehende Komorbiditäten beeinflussen das Ausmaß von Leukopenie und febriler Septikämie. Die prophylaktische Gabe von myelopoetischen Wachstumsfaktoren wird deshalb für ältere Patienten empfohlen, sobald das Risiko für eine höhergradige Hämatotoxizität (Grad III oder IV nach WHO-Kriterien) erwartet wird. Bislang existieren keine prognostischen Tests, die das individuelle Risiko der Hämatotoxizität vorhersagen können.
Abstract
According to a model described by Balducci, the human myelopoietic stem cell reserve shows a shift from the reproductive to the proliferative pool corresponding to higher immunological demands resulting from the breakdown of infection defences. Every “hematopoietic stress,” i.e., sepsis and/or cytoreductive chemotherapy, leads to a reduction of myelopoietic stem cells in the elderly in contrast to an increase in younger individuals. These changes are relevant starting at the age of 70 years and show a reduced compensation capacity in the aged organism. In addition, the function of the effector cells, i.e., the granulocytes and especially their phagocytic capacity, as well as the balance between stimulating and inhibiting cytokines are compromised. A significant influence on leukopenia and febrile septicemia has been shown for several comorbidities, especially chronic inflammation. The prophylactic use of myelopoietic growth factors is, therefore, recommended for the elderly when there is an expected risk for hematotoxicity grade III or IV. However, prognostic tests to predict the individual risk of hematotoxicity and septicemia are lacking.
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Der korrespondierende Autor weist auf folgende Beziehung/en hin: Beraterfunktion der Fa. Janssen-Cilag im Rahmen der Initiative Geriatrische Hämatologie und Onkologie (IN-GHO).
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Kolb, G. Myelopoese und Knochenmarkfunktion des alten Tumorpatienten. Z Gerontol Geriat 45, 197–200 (2012). https://doi.org/10.1007/s00391-012-0323-5
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DOI: https://doi.org/10.1007/s00391-012-0323-5