供者型CIK细胞输注治疗异基因造血干细胞移植后白血病复发  

Relapse after hematopoietic stem ceil transplantation： Report of two cases and review of literature

作　　者：李青[1] 吴耀辉[1] 仲照东[1] 游泳[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》2013年第2期75-78,共4页Chinese Journal of Organ Transplantation

基　　金：湖北省卫生厅科研项目（JX5B07）;国家青年基金（81000211）

摘　　要：目的采用受者体内供者型或供者来源的细胞因子诱导杀伤细胞（CIK细胞）过继性免疫治疗异基因造血干细胞移植（allo—HSCT）后白血病复发的效果。方法回顾性分析2例allo—HSCT后白血病复发患者输注供者型CIK细胞成功开展过继性免疫治疗的临床资料。例1在移植后986d出现白血病复发，经化疗取得短暂部分缓解，采集受者外周血完全供者型单个核细胞扩增CIK细胞，先后给予受者5个周期的CIK细胞治疗。例2在亲缘allo—HSCT后158d出现白血病复发，采集亲缘供者外周血单个核细胞扩增CIK细胞，于移植后204d和294d给予2个周期的CIK细胞输注治疗。结果例1经化疗降低白血病细胞负荷后，经过1个周期的CIK细胞输注治疗，获得完全缓解，之后再次给予4个周期CIK细胞治疗，随访7个月取得持续完全缓解。例2复发后停用免疫抑制剂，并行化疗及输注供者干细胞采集物，于移植后187d出现急性移植物抗宿主病及髓外浸润情况，移植后204d输注1个周期的CIK细胞后，症状明显减轻。移植后294d给予第2个周期的CIK细胞治疗，骨痛缓解，现骨髓细胞学持续完全缓解，髓外病灶消失。结论受者体内供者型或供者来源的CIK细胞可用于allo-HSCT后白血病复发的治疗，效果良好，耐受性好。Objective To evaluate the effect of cytokine-induced killer cells （CIKs） as an adoptive immunotherapy option for treatment of leukemia relapse after allo-hematopoietic stem cell transplantation （allo-HSCT）. Methods Two cases of infusion of donor CIKs in patients with leukemia relapse after allo-HSCT were retrospectively analyzed. Patient one relapsed 986 days （ ＋ 986d） after HLA matched unrelated donor allo-HSCT. Applications of chemotherapy only resulted in short term remission, but allo-CfKs were successfully expanded from the patient＇s peripheral blood mononuclear cells of donor origin. Totally five cycles of CIKs infusion were infused as an alternative of adoptive immunotherapy. Patient two had recurrent in the ＋ 158d after HLA-matched sibling allo- HSCT. At ＋ 204d and ＋ 294d, two cycles of CIKs which were expanded from donor peripheral blood mononuclear cells were infused. Results One cycle of CIKs was given to patient one after the application of chemotherapy to reduce the tumor burden, and the patient successively achieved complete remission. Again after additional four cycles of CIKs infusion, consistent remission was maintained during the following seven months. Patient two who had relapsed disease post- transplantation, achieved cytological complete remission after withdrawal of immunosuppressants and undergoing chemotherapy combined with G-CSF mobilized stem cell infusion. However, at ＋ 187d, the patient suffered from side-effect of acute graft versus host disease and extramedullary infiltration. The symptoms were alleviated markedly after one cycle of CIKs infusion at ＋ 204d. Moreover, the pain disappeared after an additional infusion at ＋ 294d. And up to the present, the bone marrow aspiration showed complete remission while the extramedullary disease vanished. Conclusion The use of CIKs in the treatment of leukemia relapse after allogeneic bone marrow transplantation can be feasible and well tolerated.

关 键 词：造血干细胞移植 白血病 复发 供者 CIK细胞 

分 类 号：R733.7[医药卫生—肿瘤]