GM—CSF治疗异基因造血干细胞移植后残留疾病二例  

GM-CSF as an option for treatment of residual disease after allo-HSCT

作　　者：仲照东[1] 刘仲萍[1] 游泳[1] 朱晓健[1] 王晓庆[1] 谢慧[1] 陈智超[1] 邹萍[1] 

机构地区：[1]华中科技大学同济医学院附属协和医院血液病研究所,武汉430022

出　　处：《中华器官移植杂志》2012年第2期82-85,共4页Chinese Journal of Organ Transplantation

摘　　要：目的 总结粒细胞-单核细胞集落刺激因子（GM-CSF）治疗异基因造血干细胞移植（allo-HSCT）后血液系统恶性肿瘤残留疾病两例的经验.方法 例1为骨髓增生异常综合征患者,在非血缘HSCT后半年出现骨髓病态造血和不完全嵌合状态,停用免疫抑制剂3周,未出现移植物抗宿主病（GVHD）；例2为B淋巴细胞急性淋巴细胞白血病患者,移植后30d检测到分子水平的残留疾病.两例均皮下注射GM-CSF 300 μg,隔日1次,应用3周.在此过程中观察患者皮疹情况和肝功能,监测外周血淋巴细胞和髓系衍生抑制性细胞亚群、树突状细胞（DC）的变化.结果 例1应用GM-CSF 1周后出现皮肤Ⅰ度急性GVHD,3周后出现Ⅱ度（皮肤和肝脏）急性GVHD,停用GM-CSF.治疗1个月时骨髓细胞形态学正常,转为完全供者嵌合状态,给予环孢素A（CsA）、吗替麦考酚酯和甲泼尼龙治疗2周而缓解.例2维持CsA（全血浓度为0.134～0.472 μmol/L）治疗,在使用GM-CSF后第9天,出现Ⅰ度急性GVHD,第11天出现Ⅱ度急性GVHD（皮肤）,加用泼尼松30 mg/d,共用5d,其后维持Ⅰ度急性GVHD.第30天复查,为分子生物学缓解.2例治疗前后,未发现淋巴细胞亚群变化,但DC有增加趋势,髓系衍生抑制细胞有减少趋势.结论 GMCSF可用于血液系统恶性肿瘤患者HSCT后残留疾病的治疗.Objective To evaluate the primary effect of granulocyte-monocyte colony stimulating factor （GM-CSF） as an immunotherapy option for treatment of residual disease after alloHSCT.Methods Immunotherapy was performed on two patients with blood malignancy to treat residual disease after allo-HSCT. The patient one,who was diagnosed as having MDS-RAEB Ⅱ,showed bone marrow displasis and incomplete chimerism 6 months after unrelated donor HSCT.Immunosuppressive drug was withdrawn without induction of graft-versus-host disease （GVHD）.The patient two B-ALL demonstrated a residual disease at molecular level 30 days post-transplantation.Both of them were given GMCSF （300 μg） subcutaneously once every two days for totally three weeks.During the whole period,skin itch and rash,liver function,subgroups of lymphocytes,and MDSCs and DCs in peripheral blood were investigated.Results In case one,grade Ⅰ skin acute GVHD （aGVHD） appeared as early as one week after GM-CSF administration,as well as grade Ⅱ （skin and liver） by the end of the third weeks,and GM-CSF injection was withdrawn.One month later since the start of GM-CSF,the patient showed normal bone marrow morphology and full donor type chimerism. Cyclosporine A （CsA）, mycophenolate mofetil and methylprednisolone were administered for two weeks to control GVHD.In the other case,grade Ⅰ aGVHD occurred 9 days after GMCSF administration,and whole blood CsA maintained at 0.134-0.472 μmol/L.Prednisone （30mg per day for 5 days） was used to control grade Ⅱ GVHD from the 11th day after GM-CSF,and grade Ⅰ GVHD continued without any intervention.On the 30th day after GM-CSF treatment,bone marrow aspiration showed complete molecular remission.In both of the two cases,no differences in lymphocytic subtypes were revealed before and after GM-CSF administration,while there were trends of increased DC number and decreased MDSCs in peripheral blood.Conclusion The administration of GM-CSF as an immunotherapy option for blood malignancy may contribute to t

关 键 词：造血干细胞移植 肿瘤 残余 粒细胞单核细胞集落刺激因子 治疗 

分 类 号：R457.7[医药卫生—治疗学]