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免疫毒素去除T细胞在异基因造血干细胞移植中的应用
引用本文:赖悦云,郭乃榄,黄晓军,许兰平,陈欢,汪素琴,郑海音,黎燕,沈倍奋,陆道培. 免疫毒素去除T细胞在异基因造血干细胞移植中的应用[J]. 中国实验血液学杂志, 2004, 12(3): 270-273
作者姓名:赖悦云  郭乃榄  黄晓军  许兰平  陈欢  汪素琴  郑海音  黎燕  沈倍奋  陆道培
作者单位:1. 北京大学人民医院,血液病研究所,北京,100044
2. 军事医学科学院基础医学研究所分子免疫室,北京,100850
基金项目:国家 8 63课题资助项目 ,编号 10 2 -0 9-0 1-0 3
摘    要:观察应用免疫毒素部分去除T细胞(TCD)的方法进行人类白细胞抗原/混合淋巴细胞培养(HLA/MLC)不相合异基因造血干细胞移植的临床疗效。采用蓖麻免疫毒素部分去T细胞对13例恶性血液病患者行HLA-MLC配型不相合的造血干细胞移植,其中慢性髓性白血病(CP1)6例;急性淋巴细胞白血病CR1 1例,CR2 1例,复发1例;急性髓性白血病CR1 2例,CR2 1例;骨髓增生异常综合征转化成急性髓性白血病M4型(CR1)1例。结果表明:13例患者中8例成功植入,其中2例发生Ⅱ度急性移植物抗宿主病(aGVHD),2例发生Ⅲ-Ⅳ度aGVHD。随访8-90个月,2例发生Ⅲ-Ⅳ度aGvHD患者早期死亡,另有1例患者死于迟发感染,其余5例均无病存活至今。5例未植活的患者中4例回输同一供者外周血造血干细胞后3例未植入,1例植活,但死于移植相关合并症;1例再次行同基因造血干细胞移植成功并无病存活至今。结论:采用蓖麻免疫毒素部分去T细胞的方法行HLA/MLC配型不相合的异基因造血干细胞移植可减少重度aGVHD的发生,但移植早期排斥率(HVG)较高,临床应用效果有待进一步评估。

关 键 词:造血干细胞移植 异基因造血干细胞移植 免疫毒素去除T细胞 移植物抗宿主病 白血病
文章编号:1009-2137(2004)03-0270-04
修稿时间:2003-07-03

Application of Ricin-Immunotoxin Mediated T Cell Depletion to Allogeneic Hematopoietic Stem Cell Transplantation
Yue-Yun Lai,Nai-Lan Guo,Xiao-Jun Huang,Lan-Ping Xu,Huan Chen,Su-Qin Wang,Hai-Yin Zheng,Yan Li,Bei-Fen Shen,Dao-Pei Lu. Application of Ricin-Immunotoxin Mediated T Cell Depletion to Allogeneic Hematopoietic Stem Cell Transplantation[J]. Journal of experimental hematology, 2004, 12(3): 270-273
Authors:Yue-Yun Lai  Nai-Lan Guo  Xiao-Jun Huang  Lan-Ping Xu  Huan Chen  Su-Qin Wang  Hai-Yin Zheng  Yan Li  Bei-Fen Shen  Dao-Pei Lu
Affiliation:Institute of Hematology, People's Hospital, Peking University, Beijing 100044, China. laiyueyun1008@yahoo.com.cn
Abstract:This study was aimed to investigate the clinical outcome of ricin-immunotoxin mediated T cell partially depleted HLA/MLC mismatched allogeneic hematopoietic stem cell transplantation. 13 patients with hematological malignancies were treated by ricin-immunotoxin mediated T cell partially depleted allogeneic hematopoietic stem cell transplantations from HLA/MLC mismatched donors,including 6 cases of CML in CP 1,1 case of ALL in CR 1,1 case of ALL in CR 2,1 case of ALL in relapse,2 cases of AML in CR 1,1 case of AML in CR 2,1 case of MDS-RAEBT-AML (M 4) in CR 1. The results showed that 8 cases were engrafted successfully,2 cases of them developed grade II acute GVHD and 2 cases developed grade III-IV acute GVHD. Within following-up of 8-90 months,2 patients who experienced grade III-IV acute GVHD died early after transplantation;1 patient died of late onset of infection;the other 5 patients survived free from diseases. After failure at first infusion,4 patients were given reinfusion of peripheral blood hematopoietic stem cells from the same donor. 3 out of 4 cases failed to engraft and only one patient got engraftment but died of related complications of transplantation. One patient was performed a second transplantation from a syngeneic donor and survive free of disease until now. In conclusion,T cell partially depleted HLA/MLC mismatched allogeneic hematopoietic stem cell transplantation by ricin-immunotoxin decreases the occurrence of severe acute GVHD but with high risk of rejection,which clinical outcome still needs further evaluation.
Keywords:hematopoietic stem cell transplantation  allogeneic hematopoietic stem cell transplantation  immunotoxin mediated T cell depletion  graft versus host disease  leukemia
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