预防性G-CSF动员后供者淋巴细胞输注对高危白血病患者非清髓造血干细胞移植术后复发及移植物抗宿主病的影响  

Prophylactic G-CSF mobilized donor lymphocytes infusion after non-myeloablative stem cell transplantation prevents relapse in patients with high-risk leukemia

作　　者：赵红霞 孙万军 李洁 乔均晓 黄雅静 胡海兰 艾辉胜[2] 

机构地区：[1]解放军第二炮兵总医院血液科,北京100088 [2]解放军第三0七医院

出　　处：《中华血液学杂志》2013年第11期922-925,共4页Chinese Journal of Hematology

摘　　要：目的观察预防性G．CSF动员后供者淋巴细胞输注（pG．DLI）对高危白血病患者非清髓造血干细胞移植（NST）术后复发及移植物抗宿主病（GvHD）的影响。方法12例高危白血病患者中Ph＋急性淋巴细胞白血病（ALL）1例，ALL未缓解1例，伴中枢神经系统白血病的急性髓系白血病（AML）3例，AML未缓解1例，急性双表型白血病1例，骨髓增生异常综合征（MDS）转化的AML2例，慢性髓性白血病（CML）加速期1例、急变期2例。在HLA全相合同胞NST后30天（＋30d）～＋40d内，在无GVHD发生情况下，预防性给予冻存的pG．DLI。观察pG—DLI对供者细胞植入率、GVHD发生以及疾病复发的影响。结果12例高危白血病患者中位年龄38（29～52）岁，pG—DLI中位时间为＋35（＋32～＋40）d，输注单个核细胞中位数为2．3（1．8-4．5）×108／kg，CD34＋细胞中位数为1．7（0．9～3．9）×106／kg，CD3＋细胞中位数为0．6（0．4-1．1）×108／kg。在pG—DLI后有2例患者由供受者混合嵌合转变为完全供者嵌合。仅2例发生输注相关的Ⅱ度急性GVHD，治疗后控制。有6例患者发生慢性GVHD，其中累及皮肤3例，累及皮肤、肠道2例，累及肝脏1例。有1例患者因慢性GVHD死亡。中位随访40（24～64）个月，总生存率为58．3％，无病生存率为58．3％。结论NST术后早期进行pG—DLI在一定程度上增加移植物抗白血病效应，控制疾病复发而不增加急性GVHD风险。Objective To evaluate the anti-leukemia effects of prophylactic G-CSF mobilized donor lymphocytes infusion （pG-DLI） and its relationship with the incidence of graft-versus-host disease （GVHD） in high-risk leukemia patients with non-myeloblative stem cell transplantation （NST）. Methods 12 patients with high-risk leukemia were analyzed, including Ph＋ acute lymphocytic leukemia （n=l）, acute leukemia （AL） with persistent non-complete remission （n=2）, acute myeloid leukemia （AML） with central nervous system （CNS） relapse （n=3）, hybrid AL （n=l）, secondary AML evolving from myelodysplastic syndrome （MDS/AML） （n=2）, chronic myeloid leukemia in accelerated phase （CML- AP） （n=l）, CML in blastic phase （CML- BP） （n=2）. All patients received non- myeloablative conditioning and pG-DLIs were administered 30-40 days post transplantation if no signs of GVHD were present. The percentage of donor cell chimera was analyzed by short tandem repeat-polymerase chain reaction （STR-PCR） just before and after pG-DLI. The incidence of leukemia relapse and GVHD were observed. Results 12 high-risk leukemia patients with a median age of 38 （range： 29-52） years received pG-DLI at a median interval of 35 （32-40） days. The median numbers of infused mononuclear cells （MNCs）, CD34＋, and CD3＋ cells/kg recipient body weight was 2.3 × 108/kg, 1.7 × 106/kg, and 0.6× 108/kg, respectively. 10 of 12 patients had full donor chimera before pG-DLIs and conversion from mixed to full donor chimera occurred in the other 2 patients shortly after pG-DLI. Grade II acute GVHD （aGVHD） was observed in only 2 patients and chronic GVHD （cGVHD） developed in 6 patients, including involvement of skin （n=3）, skin and intestine （n=2）, liver （n=l）. 1 patient died of cGVHD. With a median follow-up of 40 （24-64） months, 7 patients are alive in remission, with 3-year actuarial overall survival （OS） and disease-free survival （DFS） rates of the same 58.3%. Co

关 键 词：造血干细胞移植 非清髓 供者淋巴细胞输注 白血病 

分 类 号：R733.7[医药卫生—肿瘤]