干扰素-α治疗Ph+慢性粒细胞白血病的细胞遗传学反应分析

为了研究慢性粒细胞白血病 (CML)慢性期患者应用干扰素 α (IFN α)治疗后细胞遗传学疗效及其影响预后的因素 ,对我院 10年来 12 8例CML慢性期患者单用IFN α或联用化疗药物后细胞遗传学变化、核型演变及与临床有关特征的关系进行了回顾性分析。核型分析全部应用G 显带 ,部分联合应用荧光染色体原位杂交技术检测。结果表明 :①所有患者均获血液学缓解。② 118例Ph染色体标准易位患者中 36例 (30 .8% )获细胞遗传学反应 ,其中 2 0例 (17.1% )Ph染色体仍 >35 % ,13例 (11.1% )Ph染色体 <35 % ,3例 (2 5 % )Ph染色体为 0 ,达完全细胞遗传学缓解 ,细胞遗传学有效应者共 16例 (13.6 % )。③ 7例复杂变异易位患者中 4例获细胞遗传学反应 ,其中2例 (14 .3% )Ph染色体 >35 % ,2例 (14 .3% )Ph染色体 <35 % ,无 1例Ph染色体为 0 ;3例简单变异易位患者无 1例获细胞遗传学疗效。④IFN α治疗后影响细胞遗传学疗效的因素有 :性别、初诊病情、IFN α是否联用其他化疗药物及是否持续治疗。⑤IFN α治疗并不能防止CML疾病进展。结论 :①每周IFN α 6 0 0 - 90 0万U单用或联合Bu/Hu可使 11.1%的标准易位和少数复杂变异易位Ph+ CML患者获主要细胞遗传学效应 ,但不能防止疾病进展 ;②Ph变异易位并不预示IFN α疗效不佳 ;     

IFN-α对体外培养CML-DC功能、表达- 趋化因子及其受体的影响

为了研究α干扰素(IFN-α)对慢性粒细胞白血病(CML)来源的树突状细胞(DC)分泌趋化因子、表达趋化因子受体及其功能的影响,取13例CML慢性期患者骨髓单个核细胞,在小牛血清培养体系中诱导培养CML来源的DC,以rhSCF、rhFlt3L作为扩增体系的细胞因子,加入rhGMCSF、rhTNFα、rhIL4,加或不加rhIFN-α诱导DC的生成,培养2周后流式细胞术检测培养细胞的免疫表型,ELISA法检测培养上清液中CMLDC分泌MIP3-β的含量,MTT法检测CMLDC刺激健康人外周血T淋巴细胞增殖能力。结果表明:IFN-α组培养所获DC表面CD86、CD83、CD40、MHCⅠ类分子、CCR7的表达均高于对照组(P<0.01);IFN-α组诱导培养的CMLDC表达MIP3β较对照组明显增高(P<0.01);IFN-α组诱导培养的CMLDC刺激异体T淋巴细胞增殖的能力较对照组明显增强(P<0.01)。结论:IFN-α可能部分通过纠正CMLDC的免疫表型以加速CMLDC的成熟,增强CMLDC的功能。     

CD^＋34干／祖细胞与纤维连接蛋白的粘附在慢性粒细胞白血？…

探讨ＣＤ＾＋３４干／祖细胞与纤维连接蛋白（ＦＮ）的粘附在慢性粒细胞白血病（ＣＭＬ）发病中的作用。方法①采用细胞术双标记法检测初治ＣＭＬ慢性期３０例正常骨髓１０份ＣＤ＾＋３４细胞上整合素β１链（ＣＤ２９）和α４链（ＣＤ４９ｄ）的表达;②结晶紫染色法观察免疫磁珠分选的ＣＭＬ慢性期５例和５名正常人骨髓ＣＤ＾＋３４细胞ＦＮ的粘附功能;③极限稀释液体微培养观察ＦＮ对正常和ＣＭＬ慢性期骨髓粒细胞－巨噬细胞祖细     

Treatment of marrow stroma with interferon-alpha restores normal beta 1 integrin-dependent adhesion of chronic myelogenous leukemia hematopoietic progenitors. Role of MIP-1 alpha.

The mechanisms by which interferon-alpha (IFN-alpha) restores normal hematopoiesis in chronic myelogenous leukemia (CML) are not well understood. We have recently demonstrated that IFN-alpha acts directly on CML hematopoietic progenitors to restore their adhesion to marrow stroma by modulating beta 1 integrin receptor function. In the present study we examined the effect of IFN-alpha treatment of marrow stroma on subsequent adhesion of CML progenitors. Stromal layers were preincubated with IFN-alpha (10,000 microns/ml) for 48 h. Subsequent coincubation with CML progenitors for 2 h resulted in significantly increased adhesion of CML progenitors. We demonstrated that alpha 4 beta 1 and alpha 5 beta 1 integrin receptors were involved in the enhanced adhesion of CML progenitors, suggesting that IFN-alpha-treated stroma can upregulate CML integrin function. This effect is due, at least in part, to IFN-alpha-induced increased stromal production of the chemokine macrophage inflammatory protein-1 alpha (MIP-1 alpha), which upregulates beta 1 integrin-dependent adhesion of CML progenitors to stroma. Thus, IFN-alpha treatment of marrow stroma restores beta 1 integrin-dependent adhesion of CML progenitors, at least in part through induction of MIP-1 alpha production. These observations provide further insights into mechanisms by which IFN-alpha may restore normal hematopoiesis in CML.     

In vivo effects of imatinib mesylate on human haematopoietic progenitor cells

BACKGROUND: Imatinib mesylate has considerable antineoplastic activity in patients with chronic myeloid leukaemia (CML) and some solid tumours. Although originally regarded as nontoxic for normal haematopoiesis, mild to moderate myelosuppression is a commonly observed side-effect of this treatment. Recently, this molecule has been shown to suppress normal haematopoietic progenitor cells in vitro. This is the first study that has investigated the effect of imatinib on haematopoietic progenitor cells in vivo. MATERIALS AND METHODS: We investigated the number of circulating haematopoietic progenitor cells in 79 patients with CML and five patients with solid tumours who were treated with imatinib for at least 3 months. Bone marrow progenitor cells were assessed in a subgroup of 18 patients with CML after 12 months of imatinib treatment. Results were compared with haematopoietic progenitor cell numbers of normal controls. RESULTS: Circulating progenitors of all classes were significantly decreased in CML up to 24 months of imatinib therapy compared with healthy controls (median progenitor cells in CML after 12 months: CFU-GM 62, range 0-2543; BFU-E 216, range 0-3259; CFU-GEMM 0, range 0-139; versus controls: CFU-GM 208, range 50-936; BFU-E 690, range 120-1862; CFU-GEMM 20, range 4-77; P < 0.001). Similar reductions in the number of progenitor cells derived from bone marrow were found in a subgroup of 18 patients with CML. In patients with solid tumours the number of circulating progenitor cells was significantly lower under treatment with imatinib when compared with the controls. Withdrawal of imatinib in a patient with a malignant brain tumour resulted in a prompt normalization of circulating progenitors. CONCLUSIONS: This study suggests that imatinib exerts myelosuppressive effects through inhibition of haematopoietic progenitor cells.     

细胞因子体外诱导慢性髓细胞性白血病树突状细胞分化的研究

本研究探讨干扰素（IFN）治疗慢性粒细胞性白血病（CML）的可能新机制，为临床治疗CML提供新的思路。用Ficoll密度离心法分离骨髓单个核细胞（BMMNC），用不同细胞因子组合体外诱导培养树突状细胞（DC），在倒置显微镜及光镜下观察DC形态，应用流式细胞术检测其表面标志（CD1a，CD83，CD86，HIA-ABC，HIA-DR，CD54）。MTT法检测其混合淋巴细胞反应（MLR）能力。结果表明：经不同细胞因子组合所诱导出的DC，其特征性表面分子表达率均高于培养前的DC（P〈0．01）；IFN-α＋GM-CSF组DC表达HLA—ABC、HLA-DR明显高于IL-4＋GM-CSF培养组（P〈0．05）；而IFN-α＋GM-CSF4-IL-4组DC的CD86表达率及MLR水平均高于其它细胞因子组合组（P〈0．05）。干扰素耐药组DC表面分子表达率及MLR水平较新诊断组和干扰素治疗有效组均明显减低（P〈0．05），但A、B、C各组的CD86表达率及MLR水平在IFN-α＋GM-CSF4-IL-4因子组合条件下无明显差异。结论：CML骨髓单个核细胞在含有IFN-α的细胞因子组合条件下可分化为具有形态和免疫表型特征的DC，且表达较高的Ⅰ类和Ⅱ类分子、共刺激分子、黏附分子及MLR，表明干扰素治疗CML的机理可能与DC有关，这一结果提示通过增强内源性DC功能可能提高CML临床疗效。     

慢性髓性白血病人源树突状细胞的细胞毒作用及其体外扩增

本研究观察来源于慢性髓性白血病患者的CD34 细胞经两步培养扩增后产生的树突状细胞的抗白血病 免疫功能。从慢性髓性白血病患者骨髓或外周血中分离出CD34 细胞或外周血单个核细胞分别进行两步培养。 首先将其与rhFlt3-L和rhTPO共育7天,再与rhGM-CSF、rhTNF-α及rhIL-4共同培养14天,以诱导树突状细胞产 生:同时以rhGM-CSF、rhTNF-α及rhIL-4直接诱导体系作对照。获得的DC通过流式细胞仪检测免疫表型,电镜分 析细胞超微结构及G显带法进行的染色体分析后,并用MTT法检测DC刺激T细胞增殖能力及T细胞对CML细 胞的杀伤作用.结果表明:慢性髓性白血病的CD34 细胞经过rhFlt3-L和rhTPO的初始扩增培养7天后,CD34 细 胞总数扩增77±5倍。用rhGM-CSF、rhTNF-α及rhIL-4诱导培养14天,DC产率达到(39±8)％,细胞扩增倍数及 DC比例均明显高于直接诱导产生的培养方法(P<0.01),且此DC能刺激自体或异体T细胞增殖,进而杀伤CML 细胞。结论:两步法体外扩增培养可明显提高DC前体总数及产率,优于直接诱导培养;CML细胞来源的DC可诱 导产生抗白血病免疫反应。     

双色荧光原位杂交用于慢性粒细胞白血病干扰素治疗效果的监测

为了探讨双色荧光原位杂交（D-FISH）方法对CML病人干扰素治疗后疗效监测的意义，本研究采用D-FISH方法对慢性粒细胞白血病（CML）病人应用干扰素治疗前后骨髓间期核细胞进行bcr/abl融合基因的检测，并与RT-PCR方法检测bcr/abl mRNA及传统细胞遗传学方法检测Ph染色体的结果进行比较。结果显示，22例CML病人D-FISH bcr/abl融合基因在干扰素治疗前均为阳性，其平均检出率在干扰素治疗前后分别为96.4％和58.6％，其中2例治疗前P染色体阴性病人，D-FISHbcr/abl融合基因在干扰素治疗前后平均检出率分别为94.0％和70.1％。D-FISH方法检测的22例病人中，4例为部分反应，4例为微小反应，其余14例为无反应。与传统的细胞遗传学方法相比较具有良好的相关性。结果：D-FISH方法直接检测CML病人间期核细胞的bcr/abl融合基因，克服了传统的细胞遗传学只能进行分裂中期核细胞分析及RT-PCR方法不能定量检测的不足，为CML干扰素治疗后克隆缓解程度的评定提供了更方便、可靠的方法。     

Harvesting of committed hematopoietic progenitor cells (CFU-GM) by hemapheresis

In order to investigate collection of committed hematopoietic progenitor cells (CFU-GM) by hemapheresis, four protocols using a discontinuous cell separator (Haemonetics) were evaluated. The combined platelet and granulocytapheresis procedure using hydroxyethyl starch (HES) but no steroids was significantly more efficient (75%) than a standard plateletapheresis (40%, p less than 0.001) or a plateletapheresis modified by either using HES during the collection (49%, p less than 0.05) or pretreating the donors with steroids in an attempt to raise circulating stem cell levels prior to harvesting (46%, p less than 0.001). Donor basal CFU-GM levels were very variable but could be predicted by the circulating lymphocyte levels. In all four protocols, there was a direct correlation between the number of stem cells circulating at the start of the procedure and the final harvest. With this equipment, an appropriate transplant dose of CFU-GM could be provided for a child under 30 kg with less than seven procedures.     

紫外线照射对恶性肿瘤患者粒—单造血祖细胞集落形成和细胞活？…

目的 研究短波紫外线照射对恶性肿瘤患者粒－单造血祖细胞集落形成和细胞活力的影响。方法 应用０．５０、１００,３００、４００,８００ｍＪ／ｃｍ＾２的ＵＶＣ照射应用干细胞生长因子动员后白细胞外周血单个核细胞（ＰＢＭＮＣ）,观察７ｄ后粒－单系造血祖细胞集落（ＣＦＵ－ＧＭ）以及于ＵＶＣ照射后１,３,５,７ｄ观察细胞活力。结果 ５０,１００,２００,４００,８００ｍＪ／ｃｍ＾２ＵＶＣ照射后ＣＦＵ－ＧＭ集落个     

Combination with an antisense oligonucleotide synergistically improves the antileukemic efficacy of erucylphospho-N,N,N-trimethylpropylammonium in chronic myeloid leukemia cell lines

The aim of this study was to enhance the antileukemic efficacy of the alkylphosphocholine erucylphospho-N,N,N-trimethylpropylammonium (ErPC3) in chronic myeloid leukemia (CML)-derived cell lines by a bcr-directed antisense oligonucleotide (ASO-bcr). The mechanism was substantiated by Western blotting of the BCR-ABL expression level of CML cells, and the efficacy was substantiated by inhibition of colony formation compared with normal hematopoietic cells. The clonogenicity of K-562 cells expressing high levels of p210(BCR-ABL) was inhibited significantly by the ASO-bcr (T/C%, 30; P < 0.05) but not by ErPC3 (T/C%, 70). Combined sequential exposure to ErPC3 and the ASO-bcr, however, inhibited synergistically colony growth (T/C%, 3; P < 0.01). The colony growth of BV-173 cells expressing lower levels of p210(BCR-ABL) than K562 cells was inhibited to a greater extent by the ASO-bcr (T/C%, 15; P < 0.01). AR-230 cells that express high levels of p230(BCR-ABL) showed an intermediate decrease in colony formation in response to the ASO-bcr (T/C%, 20; P < 0.05). BCR-ABL levels of BV-173, CML-T1, and LAMA-84 cells were reduced in response to the ASO-bcr, as evidenced by Western blot. However, K-562 and AR-230 cells showed reduced BCR-ABL expression only after repeated treatment. ErPC3 and the ASO-bcr did not reduce colony formation (CFU-GM) of normal mouse bone marrow cells from long-term bone marrow cell cultures; instead, ErPC3 stimulated colony formation (P < 0.05) and did not induce chromosomal aberrations in mouse bone marrow. In conclusion, the combination of ErPC3 with a suitable antisense oligonucleotide inhibited synergistically colony formation of CML cell lines without damaging normal cells and thus might have a bearing on the purging of autologous hematopoietic transplants in CML patients.     

Reproducible scoring of CFU-GM and BFU-E grown in collagen-based semisolid medium after a short (3 h) training

Colony counting remains an important source of variation in colony-forming unit-granulocyte-macrophage (CFU-GM) assays performed in methylcellulose or agar. We studied the reliability of colony scoring of CFU-GM assays carried out with collagen, a matrix that allows gel collection on glass slides and in situ cellular morphology. Fourteen slides were exchanged among laboratories, and two rounds of colony (CFU-GM and burst-forming units-erythrocyte [BFU-E]) counting were performed by 11 (first counting), then 8 (second counting) different laboratories, the majority of which had no previous experience of collagen gel cultures and reading. Two-way analysis of variance (ANOVA) of the first round of colony counting showed significant differences among centers in CFU-GM counts (p = 0.023) but not in BFU-E counts (p = 0.163). Coefficients of variation for the 14 slides ranged from 22% to 50% (median 28%) for CFU-GM counts and from 12% to 74% (median 23%) for BFU-E counts. After a 3 h session of collective colony reading attended by members of 8 laboratories, a second round of colony counting was performed. This time, ANOVA showed no significant difference among centers for CFU-GM (p = 0.533) and BFU-E (p = 0.328) counts, and coefficients of variation were significantly improved, with medians of 17% for CFU-GM counts and 20% for BFU-E counts. In addition, when data from the second round of readings were analyzed without the 2 centers counting consistently low (center 8) or consistently high (center 5), variance among centers was further improved for both CFU-GM (p = 0.798) and BFU-E (p = 0.619). In summary, this study shows for the first time that reproducible BFU-E and CFU-GM scoring can be achieved using collagen-based semisolid medium (now commercially available) as long as adequate training in colony identification is provided.     

Relationship between HLA-DR expression by normal myeloid progenitor cells and inhibition of colony growth by prostaglandin E. Implications for prostaglandin E resistance in chronic myeloid leukemia.

The expression of HLA-DR antigens by normal myeloid progenitor cells (CFU-GM) has been linked to inhibition of colony growth by prostaglandin E (PGE), while resistance to the inhibitory effects of PGE in chronic myeloid leukemia (CML) has been attributed to a lower fraction of HLA-DR+ CFU-GM in this disease. However, we have previously shown that virtually all CFU-GM in normal bone marrow (NBM) as well as CML peripheral blood express HLA-DR antigens, which raises the possibility that these surface molecules may not be the sole determinants of a progenitor cell's sensitivity to PGE. In order to evaluate the relationship between HLA-DR expression and prostaglandin inhibition, we partially purified NBM progenitor cells using fluorescence-activated cell sorting to prepare cell fractions with high and low HLA-DR antigen density. Normal progenitor cells with high DR density tended to form monocyte colonies in agar culture, whereas the low DR density fraction was enriched for granulocyte colony-forming cells. Inhibition by PGE was greatest in the high DR+ fraction and was largely restricted to monocyte progenitor cells. Inhibition of CFU-GM by PGE was less in CML than in NBM, but this decreased inhibition correlated with a significantly lower number of monocyte-CFU in CML. These data suggest that high HLA-DR antigen density may select for normal progenitor cells that are committed to monocyte differentiation and are, therefore, more likely to be inhibited by PGE. The relative deficit of monocyte progenitor cells in CML may partially explain the phenomenon of PGE resistance in this disease.     

RT-PCR方法检测细胞信号传导抑制因子-1(SOCS-1)mRNA在髓性白血病中的表达

为了研究细胞信号传导抑制因子（SOCS-1）在急性和慢性髓性白血病患者外周血中的表达并探讨其临床意义，用RT-PCR的方法检测急性和慢性白血病患者外周血单个核细胞中SOCS-1 mRNA的表达，并将其表达与所有患者的病情进行了分析。结果显示：在25例急性髓性白血病患者中4例SOCS-1 mRNA表达阳性，阳性率16．00％，在25例慢性髓性白血病患者中11例SOCS-1 mRNA表达阳性，阳性率44．00％，二者差异有统计学意义。在25例慢性髓性白血病患者中，无进展组（慢性期）12例，阳性2例，而进展组（加速期和急变期）13例，阳性11例，两组间差异有统计学意义。SOCS-1 mRNA阳性的CML患者，对干扰素治疗反应差，进入加速期后SOCS-1 mRNA多数呈持续阳性表达，病情进行性发展，预后极差。结论：急性和慢性髓性白血病患者外周血单个核细胞中均可检测到SOCS-1 mRNA的表达，CML患者阳性率高，加速期与急变期表达阳性者显著增多，与干扰素治疗反应及预后密切相关。     

GW003对骨髓细胞体外形成粒-巨噬细胞集落能力的影响

本研究旨在观察重组人血清白蛋白-粒细胞集落刺激因子融合蛋白（GW003）对骨髓造血细胞体外形成粒系集落能力的影响。分别抽取正常恒河猴、缓解期和化疗中pLLL患者骨髓并分离有核细胞,分别加入系列浓度的GW003、吉粒芬、G-CSF突变体,在培养12d后计数粒-巨噬细胞系集落（CFU-GM）。结果表明,GW003具有提高正常恒河猴骨髓有核细胞体外形成CFU-GM的能力,效果明显优于相同摩尔浓度的吉粒芬 及G-CSF突变体;在-定的浓度范围内,GW003浓度与恒河猴骨髓细胞形成CFU-GM的数量呈明显的剂量效应关系（r=R2=0．965,P=0．003）;GW003能提高ALL患者骨髓细胞粒系集落体外形成能力,对化疗中患者的效果更为显著,可有效缓解化疗引起的骨髓抑制。结论：GW003可显著提高骨髓细胞体外形成粒细胞集落的能力,可有效缓解骨髓抑制。     

Increased IFN-gamma synthesis by T cells from patients on imatinib therapy for chronic myeloid leukemia

Decreased Type 1 cytokine production has been observed in T cells of patients with untreated chronic myeloid leukemia (CML). The important role of T cells and T-cell cytokines in the long-term control of CML is well established, for example in allogeneic stem-cell graft recipients. This study examined whether or not molecularly targeted therapy with imatinib, an inhibitor of the BCR-ABL tyrosine kinase, improved endogenous T-cell function in patients resistant to or intolerant of previous IFN-alpha therapy. Intracellular cytokine staining and detection by flow cytometry was used to analyze the expression of the T1 cytokine IFN-gamma in T cells. To secure independence from changes in white blood cell counts during treatment, a constant number of T cells was purified from the peripheral blood before analysis of the proportion of IFN-gamma synthesizing T cells. Twenty-nine patients with CML were tested before and after a median follow-up of 3 month on imatinib. In addition, late follow-up (past the median time to best cytogenetic response) of 15 patients were obtained Twenty-nine age- and gender-matched individuals were used as healthy controls. The frequency of IFN-gamma producing T cells in CML patients resistant to or intolerant to previous IFN-alpha therapy was lower than in healthy individuals (p=0.0181, Mann-Whitney test). Imatinib therapy led to a significant increase over pre-treatment values (p<0.0001, Mann-Whitney test). Late follow-up indicated that the increase was sustained in patients not in major cytogenetic response. In contrast, in major responders levels returned towards values comparable to healthy individuals. In conclusion, treatment with imatinib achieves a significant increase in Type 1 (IFN-gamma) cytokine-producing T cells in patients with CML. This is consistent with the view that enhanced T-cell function is achievable in patients with CML, even in the absence of allo-mechanisms.     

干扰素α和白细胞介素2联合激活的白血病骨髓对K562细胞的杀…

评价于干扰素α和白细胞介素２联合激活的白血病缓解期骨髓对白血病细胞的杀伤作用。方法：半固体集浇培养法。结果：ＩＵＬ－２激活３天的白血病缓解髓对Ｋ５６２细胞有杀伤作用，杀伤对数级达０．１３－２．３０。ＩＮＦα可明显增强ＩＬ－２激活骨髓的杀伤作用，其对Ｋ５６２细胞的杀伤率可进一步提高，达０．３０〉３．１５对数级，ＩＬ－２和ＩＮＦα联合对骨髓ＣＦＵ－ＧＭ和Ｋ５６２细胞无明显抑制作用，小剂量ＩＬ－２与ＩＦ     

α干扰素对慢性髓系白血病患者异基因骨髓移植预后的影响

目的了解α干扰素(IFN-α)对慢性髓系白血病(CML)患者异基因骨髓移植(allo-BMT)预后的影响.方法分析总结1993年3月～1999年底行allo-BMT的CML第1次慢性期(CP1)患者85例.BMT前未用IFN-α治疗组30例,用IFN-α治疗55例;其中疗程<6个月30例,6～12个月15例,>12个月10例.结果经COX多元回归分析,患者年龄、性别、确诊至BMT的时间、预处理方案、停IFN距BMT时间对生存率无影响,而用IFN治疗的疗程与生存率有关;4组的植活时间、Ⅱ～Ⅳ度急性移植物抗宿主病(GVHD)、慢性GVHD、肝静脉闭塞症、白血病复发的发生率及非白血病死亡率差异均无显著性.IFN-α用药≥6个月组Ⅲ～Ⅳ度GVHD发生率比其它两组明显升高(P<0.01).与不用IFN-α组及用药>12个月组比较,IFN-α用药<6个月组5年生存率高(P<0.05),而与用药6～12个月组相比,IFN-α疗程<6个月组5年生存率也高,但差异无统计学意义.结论用IFN-α治疗半年以内,5年生存率有提高的趋势,应用半年以上有可能使Ⅲ～Ⅳ度GVHD发生率增加,但应用1年以内,对生存率没有造成不良影响.IFN对CMLallo-BMT预后的影响尚须更多资料进一步证实.