摘要
目的观察供者型细胞因子诱导的杀伤细胞（cytokine induced killer,CIK）细胞免疫治疗对异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation,allo-HSCT）后微小残留病灶（minimal residual disease,MRD）清除的疗效。方法回顾性分析我科2012年11月至2015年11月间的10例恶性血液病患者,其中急性淋巴细胞白血病5例,急性髓性白血病4例,慢性粒单细胞白血病1例。在allo-HSCT后出现分子生物学复发（7例）以及形态学复发（3例）后经减停免疫抑制剂、化疗、供者淋巴细胞输注等治疗后形态学缓解,但MRD仍阳性的患者,给予供者型CIK细胞输注治疗,分析其疗效。结果输注供者型CIK中位次数3（2~8）次。1例输注2次无效,最终血液学复发死亡;9例患者MRD转阴,其中1例输注10个月后再次复发死亡,1例因减停免疫抑制剂出现重度移植物抗宿主病死亡,另7例患者无病存活。输注CIK后中位随访时间为10（3~14）个月,中位生存时间8（3~14）个月,中位无病生存时间8（0~14）个月,其中5例患者输注CIK后无病生存时间长于移植后无病生存时间。结论供者型CIK细胞输注治疗对allo-HSCT后复发的患者可使其再次达到分子生物学缓解,减少血液学复发,提高造血干细胞移植疗效,且不良反应小。
Objective To determine the clinica1 efficacy of infusions of donor-derived cytokine induced killer（ CIK） cells in the patients having minimal residual disease（ MRD） after allogeneic hematopoietic stem cell transplantation（ allo-HSCT）. Methods Ten refractory / relapsed patients,including acute lymphoblastic leukemia（ ALL,n = 5）,acute myelogenous leukemia（ AML,n = 4）,and chronic myelomonocytic leukemia（ CMML,n = 1） admitted in our department from November 2012 to November 2015 were enrolled in this retrospective analysis. All the patients were achieved molecular remission,then relapsed again after allo-HSCT,and 7 of them achieved MRD positive status and 3 relapsed. They had received salvage treatments including stopping immunosuppressive,chemotherapy and donor lymphocytes infusion. All patients were achieved remission but had MRD positive before CIK infusion. Results The median number of CIK infusions was 3（ ranged from 2 to 8） times. However,1 case was no response to the twice infusions of CIK and died finally due to relapse. Nine patients of them achieved molecular responses after accepting the infusions of CIK. One of the 9 patients relapsed again and died 10 months after the infusions,one died of grade Ⅳ graft versus host disease after stopping immunosuppressive therapy,and the left 7 patients had stayed continuous complete remission（ CCR）. The median time of follow-up after CIK infusion was 10（ ranging from3 to 14） months. The median time of overall survival（ OS） was 8 months（ ranging from 3 to 14）,and that of event-free survival（ EFS） was 8 months（ ranging from 0 to 14）. Five patients had longer remissions after infusion of CIK cells than after allo-HSCT. Conclusion Infusion of donor-derived CIK cells is an effective therapy for the MRD-positive patients after allo-HSCT,with well tolerance,achieving molecular remission,reducing relapse,and improving efficiency of hematopoietic stem cell transplantation.
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第12期1366-1370,共5页
Journal of Third Military Medical University
关键词
造血干细胞移植
细胞因子诱导的杀伤细胞
微小残留病灶
allogeneic stem cell transplantation
cytokine induced killer cells
minimal residual diseases
