急性白血病的新型主动免疫治疗研究  

The novel active immunotherapy of leukemia

作　　者：张王刚[1] 曹星梅[1] 杨惠云 马肖蓉 何爱丽[1] 陈银侠[1] 刘捷[1] 赵万鸿 王剑利[1] 张慧 田玮 杨国龙 杨渭临[2] 王一理[3] 司履生[3] 耿宜萍[3] 

机构地区：[1]西安医科大学第二临床医学院血液科,710004 [2]西安医科大学第二临床医学院干部病房,710004 [3]西安医科大学免疫病理室,710061

出　　处：《陕西肿瘤医学》1999年第2期70-74,共5页ShanXi Oncology Medicine

基　　金：陕西省自然科学基金!97SM35

摘　　要：目的应用化疗不能治愈大多数急性白血病，近年人们对基因工程疫苗寄以厚望，动物实验已展现其具有明显疗效，但迄今尚未见单独应用白血病疫苗主动免疫及治疗急性白血病患者取得明显疗效的报造。本文应用基因工程生产的细胞因子及白血病细胞制备的疫苗，主动免疫治疗21例急性白血病，以探讨提高主动免疫治疗急性白血病疗效的方法。方法1．新型白血病疫苗制备：取化疗前或化疗末缓解的白血病患者自身骨髓15ml，肝素抗凝，应用淋巴细胞分离液分离出富含白血病细胞的骨髓单个核细胞，经丝裂霉素处理后，加入含基因工程生产的粒单细胞集落刺激因子，白细胞介素2及白细胞介素6等的福氏佐剂中。2．主动免疫治疗程序：对所有接受免疫治疗患者在停用化疗两周后进行骨髓检查并开始接种疫苗。每次用合108个白血病细胞的疫苗1．6ml，分两点前臂皮下注射，每隔7天重复一次，共4次，然后长期随访。如无效时再改用其它治疗；如有效，每隔6个月加强注射一次。结果21例急性白血病患者均因化疗无效或不能耐受而改用疫苗治疗。免疫治疗达到完全缓解（CR）者5例，为24％；部分缓解（PR）者4例，为19％；微效（MR）者3例，为14％。总有效率达到57％。有效者多为女性，低增生性急性单核细胞白血病（M5）。疗效平均持续时间约7?objective Since chemotherapy can not cure most leukemia, new attention has been given on the active immunotherapy again in recent years. We observed the clinical effect of a novel leukemic vaccine on 21 patients with leukemia, on whom the chemical therapy had failed to take effect. Methods Preparation of vaccine:The novel leukemic vaccine was prepared from the inactivated self leukemic cell,combining with Freund adjuvant, to which IL-2, IL-6 and GM-CSF were added. Procedures of therapy: All patients were inoculated after 14 days of chemotherapy cease and the expression of B7,a kind of costimulatory molecules in leukemic cell membrance,was measured by immunoflurscence just be fore the immunotherapy. Every patient was injected subcutaneously with 2ml vaccine once a week for 4 weeks. Then, a1l therapy was stopped to observe the efficacy and side effect. Results 5 in 11 acute monocytic leukemia (M5)and 2 in 4 acute lymphocytic leukemia had achieved completed and partial remission only using the vaccine after 6 weeks of immunotherapy with the effective rates 45% and 5O%,respectively. Before the immunotherapy,the load of leukemic cells of these CR patients was small. Averagely, the remission kept up for 7 months. However no efficacy was observed on 4 patient with 1 M2, 1 M3, 2 M4 and 2 chronic myeloid leukemia (CML) transformed to ANLL. 5 patients with the efficacy presented local swelling at sites where the vaccine had been injected and leukemic cell membrance of these patients all expressed B7 while the patients without effect showed no obvious swelling and the leukemic cell membrance didn' t express B7. No other side effect was observed in all patients with the vaccine injection. Conclusion The results showed that the active immunotherapy with our this novel leukemic vaccine has apparent effect on some patients with acute monocytic and lymphocytic leukemia, whose leukemic cell membrance express costimulatory molecules,especially B7.

关 键 词：急性白血病 主动免疫治疗 疗效 

分 类 号：R733.71[医药卫生—肿瘤] R730.51[医药卫生—临床医学]