急性髓系白血病患者异基因造血干细胞移植后aGVHD的发生与移植物中免疫细胞成分的关系  

The Relationship between Occurrence of aGVHD in Patients with Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation and Immune Cell Components in Graft

作　　者：刘硕 周征 翟文静 宋希拿 李强 姜尔烈 冯四洲 孙佳丽 LIU Shuo;ZHOU Zheng;ZHAI Wen-Jing;SONG Xi-Na;LI Qiang;JIANG Er-Lie;FENG Si-Zhou;SUN Jia-Li(State Key Laboratory of Exprimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)

机构地区：[1]中国医学科学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020

出　　处：《中国实验血液学杂志》2023年第2期539-545,共7页Journal of Experimental Hematology

基　　金：中国医学科学院课题(2021-I2M-C&T-B-083)。

摘　　要：目的:分析异基因造血干细胞移植(allo-HSCT)治疗急性髓系白血病(AML)时,患者急性移植物抗宿主病(aGVHD)的发生与移植物中各类免疫细胞成分之间的关系。方法:回顾性分析在中国医学科学院血液病医院接受allo-HSCT的104例AML患者的临床资料,分析其造血重建及GVHD发生情况。流式细胞术检测移植物中各类免疫细胞所占比例,计算并比较不同程度aGVHD患者各细胞成分的输注量,以分析AML患者allo-HSCT后GVHD发生的严重程度与移植物中免疫细胞成分的相关性。结果:有核细胞总数(TNC)高数量组患者造血重建所需时间与低数量组相比无显著差异,而CD34高数量组患者的中性粒细胞和血小板重建时间比CD34低数量组显著加快(P<0.05),且患者住院总时间也有缩短的趋势;无论全相合移植还是半相合移植,与未发生或发生Ι度aGVHD组(0-ΙaGVHD组)相比,发生Ⅱ-Ⅳ度aGVHD(Ⅱ-ⅣaGVHD组)患者的CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)细胞以及NK细胞和CD14^(+)单核细胞的输注量均较高,但差异无统计学意义(P>0.05);此外,半相合移植后发生Ⅱ-ⅣaGVHD组患者所输注的CD4^(+)CD25^(+)细胞量显著低于0-ΙaGVHD组(P<0.05),全相合移植患者也呈现相同趋势,但差异不显著(P=0.078)。结论:移植物中高数量的CD34^(+)细胞有利于AML患者的造血重建;输注较多的CD3^(+)、CD3^(+)CD4^(+)、CD3^(+)CD8^(+)T淋巴细胞、NK细胞或CD14^(+)单核细胞在一定程度上有增加aGVHD发生的趋势,而输注较多的CD4^(+)CD25^(+)调节T细胞有助于降低AML患者aGVHD的发生率或aGVHD发生的严重程度。Objective:To explore the relationship between occurrence of acute graft-versus-host disease(aGVHD)and various immune cell composition in patients with acute myeloid leukemia(AML)after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:The clinical data of 104 patients with AML undergoing allo-HSCT in our hospital were retrospectively analyzed,and the hematopoietic reconstitution and occurrence of GVHD were analyzed.Flow cytometry was used to detect the proportion of various types of immune cells in the grafts,the number of graft composition in patients with different degrees of aGVHD was calculated and compared,and to analyze the correlation between the severity of aGVHD in AML patients after allo-HSCT and the immune cell components in the graft.Results:There was no significant difference in the time of hematopoietic reconstitution between the high number group of total number of nucleated cells(TNC)and the low number group,while the time of neutrophil and platelet reconstruction in the high number of CD34 group was significantly faster than that in the low number of CD34 group(P<0.05),and the total hospital stay also tends to be shorten.Compared with patients in 0-ΙaGVHD group,both HLA-matched and HLA-haploidentical transplantation,the infusion amounts of CD3^(+)cells,CD3^(+)CD4^(+)cells,CD3^(+)CD8^(+)cells,NK cells and CD14^(+)monocytes were higher in patients ofⅡ-ⅣaGVHD group,but the difference was not statistically significant(P>0.05);In addition,in patients with HLA-haploidentical transplantation,the number of CD4^(+)CD25^(+)cells inⅡ-ⅣaGVHD group was significantly lower than that in 0-ΙaGVHD group(P<0.05),and the same trend was also observed in HLA-matched transplanted patients,but the difference was not significant(P=0.078).Conclusion:High number of CD34^(+)cells in the graft is beneficial to hematopoietic reconstitution in AML patients.To a certain degree,high number of CD3^(+)cells,CD3^(+)CD4^(+)cells,CD3^(+)CD8^(+)cells,NK cells and CD14^(+)cells tend to increase the occurre

关 键 词：急性髓系白血病 异基因造血干细胞移植 造血重建 淋巴亚群 移植物抗宿主病 

分 类 号：R733.71[医药卫生—肿瘤]