供者淋巴细胞输注治疗HLA不合造血干细胞移植后白血病复发

目的 观察HLA不合造血干细胞移植(HSCT)后白血病复发患者中进行供者淋巴细胞输注(DLI)的有效性及安全性.方法 对HLA不合HSCT后复发患者进行G-CSF动员的DLI联合移植物抗宿主病(GVHD)预防、部分联合化疗,并观察GVHD发生、白血病缓解以及长期生存情况.结果 24例HSCT后白血病复发患者DLI后8例发生Ⅲ～Ⅳ度GVHD.短期GVHD预防可显著减少重度GVHD发生(P=0.020).8例发生慢性GVHD.3例出现骨髓抑制.16例白血病患者获完全缓解.9例无病存活,随访时间1310(961～1914)d.移植后1年和2年无病存活率分别为60%和40%.复发时骨髓幼稚细胞数量影响DLI后的缓解率和生存率,DLI后发生慢性广泛型GVHD与白血病完全缓解呈正相关(P=0.046).3例Ph阳性急性淋巴细胞白血病全部死于复发.结论 经G-CSF动员的DLI联合GVHD预防、部分联合化疗可以作为HLA不合HSCT后白血病复发的治疗手段.

Donor lymphocyte infusion for treatment of relapse of leukemia after HLA-mismatched hematopoietic stem cell transplantation

OBJECTIVE: To observe the efficacy and safety of donor lymphocyte infusion (DLI) for treatment of leukemia relapse after HLA-mismatched hematopoietic stem cell transplantation (HSCT). METHODS: Patients received DLI were studied for the occurrence of graft-versus-host disease (GVHD) , remission of leukemia and long-term survival after granulocyte colony-stimulating factor (G-CSF). G-CSF-primed DLI and GVHD prophylaxis (some received chemotherapy). RESULTS: Acute grade III - IV GVHD was observed in 8 of 24 patients relapsed after HSCT and GVHD prophylaxis reduced the incidence (P = 0.013). Eight patients developed chronic GVHD and myelosuppression in three patients. Sixteen of twenty-four patients achieved complete remission. Nine of them survived leukemia-free for a median of 1310 (961 - 1914) days after HSCT. The 1-year and 2-year probability of leukemia-free survival was 60% and 40%, respectively. The number of blasts influenced on remission and survival. Occurrence of extensive chronic GVHD was related to higher remission rate (P = 0.046). All three patients with Ph-positive acute lymphoblastic leukemia died of relapse. CONCLUSION: The G-CSF-primed DLI with GVHD prophylaxis(some combined with chemotherapy) is a potentially effective therapeutic option for patients with relapsed leukemia after HLA-mismatched HSCT.