老年AML患者HLA不相合异基因造血干细胞微移植后细胞免疫功能恢复情况分析  

Analysis on Cellular Immune Function Recovery after HLA Mismatched Allogeneic Hematopoietic Stem Cell Micro-Transp-lantation in Elderly AML Patients

作　　者：姜姗 刘汝玉 刘铁强 王一 余长林 乔建辉 蔡博 雷阳阳 艾辉胜 郭梅 胡锴勋 JIANG Shan;LIU Ru-YU;LIU Tie-Qiang;WANG Y;YU Chang-Lin;QIAO Jian-Hui;CAI Bo;LEI Yang-Yang;AI Hui-Sheng;GUO Mei;HU Kai-Xun(The PLA 307 Clinical College of Anhui Medical University,The Fijth Clinical Medical College of Anhui Medical University,Hefei 230032,Anhui Province,China;Deparment of Hematology,The Fifth Medical Center of PLA General Hospital,Beijing 100071,China)

机构地区：[1]安徽医科大学解放军307临床学院,安徽医科大学第五临床医学院,合肥230032 [2]解放军总医院第五医学中心血液医学部,北京100071

出　　处：《中国实验血液学杂志》2023年第4期945-953,共9页Journal of Experimental Hematology

基　　金：军队医学科技拔尖项目(20QNPY116)。

摘　　要：目的:探讨微移植(MST)治疗老年急性髓系白血病(AML)患者缓解状态下细胞免疫功能的恢复情况以及再次复发时的细胞免疫功能变化及其临床意义。方法:纳入单中心接受MST治疗的老年AML患者41例及健康老年体检者25例,分析比较正常老年人不同年龄段的免疫功能差异,进一步比较经MST治疗获得持续完全缓解(CR)后不同年龄组老年AML患者与正常人群的免疫功能差异,高危组和中低危组经MST治疗获得CR后免疫功能的差异,以及该类患者诊断治疗前、诱导CR后、再次复发阶段的免疫功能。具体方法为,采集患者及健康体检者外周血,用多色流式细胞仪检测外周血淋巴细胞亚群的百分比,对数据进行统计分析。结果:经MST治疗后缓解35例,未缓解6例,各年龄段CD3^(+)和CD8^(+)T细胞、活化T细胞均高于正常值。无论高危、中低危组均可观察到CD3^(+)和CD8^(+)T细胞明显恢复,中低危组整体免疫细胞恢复情况更好。同时可以观察到B淋巴细胞和NK细胞在MST治疗后1年内始终无法恢复到正常水平。复发时与经MST治疗后持续CR状态下相比,CD3^(+)、CD4^(+)T细胞比例及CD4/CD8比值均显著下降(P<0.05)。结论:MST治疗能够促进CD3^(+)、CD8^(+)T细胞等杀伤细胞的恢复,从而提高老年患者细胞免疫功能,为老年AML提供了一种新的免疫细胞治疗方案。Objective:To investigate the recovery of cellular immunity in elderly patients with acute myeloid leukemia(AML)after micro transplantation(MST)and the changes of cellular immunity during relapse,as well as their clinical significance.Methods:A total of 41 elderly AML patients who received MST treatment in a single center and 25 healthy elderly people were included.Immune function among different age groups in normal population was compared.Furthermore,immune fuction was compared between elderly AML patients of different age groups who achieved continuous complete remission(CR)after MST treatment and normal controls,between high risk group and medium-low risk group,as well as among before diagnosis,after CR,and relapse.Peripheral blood of patients and nomal controls was collected,and the percentage of lymphocyte subsets was detected by multi-color flow cytometry.Results:Thirty-five patients achieved CR after MST treatment while six patients did not.After MST treatment,CD3^(+)T cells,CD8^(+) T cells and activated T cells in all age groups were higher than normal.Significant recovery of CD3^(+)and CD8^(+)T cells was observed in both high risk and medium-low risk groups,and the overall recovery of immune cells in medium-low risk group was better.It was also observed that B lymphocytes and NK cells could not return to normal levels within 1 year after MST treatment.The proportion of CD3^(+)T cells,CD4^(+)T cells,and CD4/CD8 ratio were.significantly decreased during relapse compared with continuous CR after MST(P<0.05).Conclusion:MST treatment can promote the recovery of CD3^(+)T cells,CD8^(+)T cells and other killer cells,so as to improve the cellular immune function of elderly patients,which provides a new immune cell therapy for elderly AML.

关 键 词：微移植 老年 急性髓系白血病 淋巴细胞亚群 细胞免疫 

分 类 号：R457.7[医药卫生—治疗学] R733.71[医药卫生—临床医学]