异基因造血干细胞移植联合供者CIK细胞过继免疫治疗复发难治血液肿瘤11例临床分析  

Allogeneic stem cell transplantation combined cytokine-induced-killer cells adaptive immunotherapy in treatment of refractory/relapsed hematologic neoplasms

作　　者：陈林[1] 史丽君[1] 陈姝[1] 邓建川[1] 周慷[1] 罗云[1] 张颖[1] 沈燕[1] 胡成琳[1] 娄世锋[1] 

机构地区：[1]重庆医科大学附属第二医院血液科,重庆400010

出　　处：《第三军医大学学报》2012年第24期2449-2452,共4页Journal of Third Military Medical University

摘　　要：目的观察异基因干细胞移植(allogeneic stem cell transplantation,allo-HSCT)联合供者细胞因子诱导的杀伤细胞(cytokine induced killer cells,CIK)过继免疫治疗复发难治血液肿瘤的效果。方法回顾性分析我科2005年3月至2012年3月行供者CIK细胞输注的allo-HSCT后复发难治血液肿瘤患者11例临床资料,其中急性髓系白血病3例,急性淋巴细胞白血病1例,慢性髓系白血病2例,多发性骨髓瘤1例,淋巴瘤4例。患者均进行亲缘allo-HSCT后给予供者CIK输注。结果移植后11例患者造血均重建,CIK细胞输注的中位次数为4(2～7)次,中位细胞总数为11.9×106/kg[(5.8～86.5)×106/kg];11例患者原发肿瘤均获完全缓解。4例移植后2～4个月再次复发(急性髓性白血病髓外复发1例,多发性骨髓瘤2例,慢粒急变1例),经供者CIK输注、停用免疫抑制剂后重获完全缓解3例。4例死亡,其中2例死于特发肺综合征,均为单倍型移植后原发肿瘤复发停用免疫抑制剂所致,另2例死于严重感染。总体中位生存时间9(2～53)个月;7例生存至今,生存时间12～53个月,除1例MM分子复发外,其余仍处于完全缓解。结论 allo-HSCT联合供者CIK过继免疫治疗血液肿瘤有明显效果,副作用小,值得进一步进行多中心病例对照研究。Objective To evaluate the clinical efficacy of donor-derived cytokine induced killer cells （CIK） after allogeneic stem cell transplantation （allo-HSCT） in the treatment of patients with refractory/ relapsed hematologic neoplasms. Methods Eleven refractory/relapsed patients, including acute myelogenous leukemia （AML） （ n = 3 ）, acute lymphoblastic leukemia （ALL） （ n = 1 ）, chronic myelomonocytic leukemia （CML） （n = 2）, multiple myeloma （MM） （ n = 1 ） and non-Hodgkin lymphoma （NHL） （ n = 4）, were enrolled in this retrospective analysis. All the patients accepted the infusions of donor-derived CIK after allo- HSCT. Results Hematopoietic reconstitution was achieved in 11 patients. The median number of CIK infu- sions was 4 （range 2 to 7） and the median number of total CIK cells was 11.9× 10^6/kg （range 5.8 to 86.5）. The primary disease achieved complete responses in all the patients. Four patient relapsed again after allo-HSCT and CIK cell infusion. However, 3 patients of them achieved complete responses after stopping immunosuppres- sive therapy and accepting the infusions of CIK. Among the 4 died patients, 2 died of idiopathic pulmonary syndrome, and 2 of severe infection. The median time of follow-up was 9 months （ranging from 2 to 53 months）. During the follow-up period, 7 patients had always stayed CCR except 1 patient relapsed in molecule biology. Conclusion Allo-HSCT combined CIK adaptive immunotherapy is an effective therapy with little side effect for minimal residual disease （MRD） clearance for malignancy, and it is worth of doing a multi-center controlled clinical trail study for its efficiency.

关 键 词：造血干细胞移植 肿瘤 细胞因子诱导的杀伤细胞 过继免疫细胞治疗 

分 类 号：R617[医药卫生—外科学] R730.51[医药卫生—临床医学]