摘要
本研究回顾分析2001年4月至2007年12月期间采用IL-2和GM-CSF体外处理的外周血单个核细胞治疗再生障碍性贫血(aplastic anemia,AA)的安全性及远期疗效。取自体外周血单个核细胞,在IL-2和GM-CSF作用下培养48小时后进行静脉回输,细胞总剂量为6×106-1×108,每周1次,连用4-22个月。外周血常规检查、骨髓细胞涂片和骨髓活检评价造血恢复,流式细胞术测定输注细胞的组成以及治疗前后T细胞亚群的变化,多聚酶链反应检测外周血T细胞TCRVβ克隆性。结果表明:49例患者中痊愈37例,随访至今无1例出现复发;5例部分缓解,3例明显进步,4例无效,总有效率91.8%(45/49)。治疗前外周血T细胞亚群CD4/CD8比例倒置者39例,治疗后31例(79.5%)恢复正常。11例患者行外周血TCRVβ克隆性分析,受抑制的亚群重新得到恢复,出现多克隆的表达图像。未发现晚期克隆性疾病及其它远期不良反应。结论 :IL-2和GM-CSF体外处理的外周血单个核细胞疗法疗效肯定,其机制可能与T细胞免疫功能的恢复有关。
This study was purposed to evaluate the long-term outcome and the safety of autologous peripheral blood mononuclear cells（PBMNC） treated by interleukin 2 （IL-2） and granulocyte-macrophage colony stimulating factor（ GM- CSF） in the therapy of patients with aplastic anemia （AA）. The therapy of 49 patients admittedBG in hospital from April 2001 to December 2007 were analyzed retrospectively. PBMNC were isolated and cultured for 48 hours in presence of IL-2 and GM-CSF. Cells were collected, and 6 × 10^6 - 1 ×10^8 PBMNC were intravenously injected weekly for 4 -22 months. Hematopoietic recovery was evaluated by examinations of peripheral blood, bone marrow aspirates and bone marrow biopsy. Flow cytometry was used to assess the peripheral T cell subsets before and after treatment. Polymerase chain reaction was performed to observe the clonal diversity of T cell receptor variable β-chain （TCR-VI3） recombina- tion. The results showed that 37 cases were cured and none of them relapsed during the follow-up, 5 cases were in partial remission, 3 cases got improvement, and 4 cases showed no response. The total efficiency reached up to 91.8%. The ratios of CD4 （ ＋ ）/CD8 （ ＋ ） subsets were abnormal in 39 patients prior to the treatment, and 31 cases restored to the normal range after cell transfusions. Analysis on the clonal diversity of TCR-VI3 recombination in 11 patients showed the transition from monoclonal or biclonal spectratype to polyclonal one. No long-term side effects were documented. It is concluded that the treatment with PBMNC treated by IL-2 and GM-CSF is generally safe and effective. The underlying mechanisms may be in relation to the restoration of cell immunity.
出处
《中国实验血液学杂志》
CAS
CSCD
2011年第3期781-786,共6页
Journal of Experimental Hematology
