微移植治疗急性髓系白血病不同预处理方案精细免疫指标的差异性研究  

Study on the difference of fine immune indexes of different conditioning regimens in microtransplantation for acute myeloid leukemia

作　　者：郑涵雪 张连生[1,2] 李莉娟[1,2] ZHENG Han-xue;ZHANG Lian-sheng;LI Li-juan(Second School of Clinical Medicine,Lanzhou University,Lanzhou 730000,China;不详)

机构地区：[1]兰州大学第二临床医学院,甘肃兰州730000 [2]兰州大学第二医院血液科,甘肃兰州730000

出　　处：《中国实用内科杂志》2025年第1期54-61,共8页Chinese Journal of Practical Internal Medicine

基　　金：国家自然科学基金(82360029);国家血液系统疾病临床医学研究中心委托课题(2021WWA01);甘肃省科技计划项目临床医学研究中心建设(21JR7RA435);甘肃省科技计划项目自然科学基金(21JR7RA394);甘肃省科技计划项目自然科学基金(21JR11RA104)。

摘　　要：目的本研究旨在观察不同微移植(MST)预处理方案对急性髓系白血病(AML)治疗后精细免疫指标的变化,探讨MST的有效免疫机制,并筛选更优化的预处理方案。方法纳入2015年8月至2024年4月就诊于兰州大学第二医院并接受MST的61例AML患者,以及14例未接受微移植直接进入维持治疗的AML患者。将MST患者分为含有维奈克拉的预处理方案组及不包含维奈克拉的预处理方案组,未接受MST患者作为空白对照组。应用流式细胞仪及流式微球捕获芯片技术(CBA)检测三组共19项精细免疫指标,观察三组间的差异及治疗前后的指标变化,分析淋巴细胞亚群与细胞因子之间的相关性。并对三组间进行Kaplan-Meier生存分析。结果微移植患者具有更好的无进展生存(PFS)和总生存期(OS)(P<0.05)。发现9个有意义的免疫指标与微移植相关,其中维奈克拉组MST后总T细胞比例和总B细胞比例升高,CD4^(+)T细胞比例、干扰素(IFN)-γ、IL-12p70降低(P<0.05),非维奈克拉组总B细胞比例升高,总T细胞、CD4^(+)T细胞比例、CD4^(+)/CD8^(+)、IL-4、肿瘤坏死因子(TNF)-α、IL-17A降低(P<0.05)。结论含有维奈克拉的预处理方案组在免疫指标变化和临床效果方面表现更优,值得进一步研究和推广应用。Objective The objective of this study was to investigate different pretreatment schemes for micro-transplantation(MST)in the treatment of acute myeloid leukemia(AML),aiming to explore the potential immune mechanisms underlying effective MST and identify optimized pretreatment strategies.Methods A total of 61 AML patients who underwent MST treatment at the Second Hospital of Lanzhou University from August 2015 to April 2024 were included,along with 14 AML patients who received maintenance therapy without MST.The MST patients were divided into venetoclax conditioning regimen group and non-venetoclax conditioning regimen group,and the patients who did not receive MST were served as control group.Flow cytometry and cytometric bead array(CBA)were used to detect a total of 19 immune indexes.Differences among the three groups,changes in fine immune indexes before and after treatment,and correlations between lymphocyte subsets and cytokines were observed.Kaplan-Meier survival analysis was performed among the three groups.Results Patients treated withmicrotransplantationhad better PFS and OS(P<0.05).A total of 9 meaningful immune markers were found to be associated with MST,specifically in venetoclax group,total T cell and B cell percentages increased,while CD4^(+)T cell percentage,IFN-γ,and IL-12p70 decreased(P<0.05).In non-venetoclax group,total B cell percentage increased,while total T cell,CD4^(+)T cell,CD4^(+)/CD8^(+),IL-4,TNF-α,and IL-17A percentages decreased(P<0.05).Conclusion Venetoclax pretreatment regimendemonstrated more favorable changes in immune indexes and better clinical outcomes,which is worthy of further research and application.

关 键 词：急性髓系白血病 微移植 精细免疫指标 免疫机制 

分 类 号：R551[医药卫生—血液循环系统疾病]