混合造血干细胞移植联合过继免疫治疗对急性髓系白血病的疗效

本研究探讨混合造血干细胞移植(mix-HSCT)后给予单倍体相合供体淋巴细胞输注(hiDLI)加白介素2(IL-2)对急性髓系白血病(AML)患者的疗效。mix-HSCT即自体外周血造血干细胞与单倍体相合异体骨髓造血干细胞混合移植,49例AML患者在完全缓解期采用全身照射加VEMAC预处理方案后,接受了mix-HSCT。所有患者均经过化疗加G-CSF方法动员自体外周血造血干细胞,或供者骨髓造血干细胞未经过G-CSF动员。试验组33例患者在造血恢复后给予hiDLI+IL-2治疗1-8次。对照组16例患者造血恢复后未做特殊治疗。随访时间>3年。结果表明:所有患者均获得造血重建,无1例发生移植物抗宿主病(GVHD)。两组患者中性粒细胞≥0.5×109/L的中位时间分别为14(12-18)d和14(11-16)d,白细胞数≥4.0×108/L的中位时间分别为17(16-22)d和18(16-20)d,血小板数≥50×108/L的中位时间分别为25(24-29)d和25(23-26)d。移植后16-21 d时显示恢复期骨髓象。试验组有9例形成混合嵌合体(46XX/46XY),持续存在时间3-12个月,随访显示存活21例,长期无病存活率为63.6%。对照组中有3例形成混合嵌合体(46XX/46XY),持续存在时间3-6个月,随访显示存活7例,长期无病存活率为50.0%。结论:mix-HSCT后应用hiDLI+IL-2治疗对AML患者的造血功能恢复正常、长期无病生存可能有积极作用。

Efficacy of Adoptive Immunotherapy after Mixed Hematopoietic Stem Cell Transplantation on Acute Myeloid Leukemia

The purpose of this study was to investigate the efficacy of treatment with haploidentical donor′s lymphocyte infusion（hiDLI） combined with interleukin-2（IL-2） after transplantation of autologous peripheral blood stem cells mixed with haploidentical allogeneic bone marrow（mix-HSCT） for acute myeloid leukemia（AML）.49 patients diagnosed as AML were enrolled in this study.After preconditioning with TBI plus VEMAC regimen,all patients received mix-HSCT.Autologous peripheral blood hematopoietic stem cells were mobilized with chemotherapy-combined G-CSF,and haploidentical allogeneic bone marrow cells were not mobilized with G-CSF.33 patients in test group were treated with hiDLI plus IL-2 for 1-8 times after hematopoietic reconstruction,16 patients in control group received mix-HSCT only.All the patients were followed-up for more than 3 years.The results showed that all the patients obtained hematopoietic reconstruction,and no graft-versus-host disease（GVHD） was found.In two groups,the median time of absolute neutrophil count（ANC） ≥0.5×109/L was 14（12-18） and 14（11-16） days,and WBC count ≥4.0×109/L was 17（16-22） and 18（17-20） days,Plt count ≥50×108/L were 25（24-29） and 25（23-26） days.9 patients in test group formed mixed chimerism（46XX/46XY） and sustained about 3-12 months;disease-free survival（DFS） was 63.6%,3 patients in control group formed mixed chimerism（46XX/46XY）,persistent about 3-6 months;DFS was 50.0%.It is concluded that treatment with hiDLI plus IL-2 after mix-HSCT for AML patients may increase DFS efficiently.