抗原负载的树突状细胞介导的抗慢性粒细胞白血病作用

目的：研究慢性粒细胞白血病（CML）细胞冻融抗原(CLA)负载的树突状细胞（DC）对特异性抗白血病T细胞的作用。方法：将健康人外周血单个核细胞来源的DC在体外用CLA负载,再与CML患者的经细胞因子诱导的杀伤细胞（CIK）共同培养,应用乳酸氢酶释放法观察其对自身CML细胞杀伤活性,与未负载的DC与CIK共培养组、CIK组分别进行比较。结果：DC经抗原负载后介导的特异性抗白血病T细胞对CML细胞杀伤活性明显增强。结论：用CLA负载可进一步提高DC介导的特异性抗白血病T细胞对CML细胞的杀伤活性。     

脂质体RNA负载慢性粒细胞白血病来源树突状细胞的性能比较

目的研究人慢性粒细胞白血病(CML)总RNA经过脂质体负载后体外转染自体慢性粒细胞白血病 树突状细胞（CML-DC）,并诱导特异性细胞毒T淋巴细胞（CTL）免疫反应。方法CML患者骨髓单个核细胞（CML-BMMNC）在rhIL-4、rhGM-CSF、rhTNF-α细胞因子联合培养诱导出CML-DC。采用Trizol法提取CML-BMMNC的总RNA;反复冻融法制备CML BMMNC抗原。于CML-DC培养第5天,加入脂质体转染的CML总RNA、CML总RNA、CML肿瘤冻融抗原及不加抗原。倒置显微镜观察DC形态学变化;流式细胞仪器检测免疫表型变化;染色体G显带技术检测其染色体核型及逆转录聚合酶链反应（RT-PCR）检测Bcr-abl融合基因的表达;用MTT法检测CTL作用。结果CML BMMNC诱导成CML-DC, CD_1α、CD₈₃表型表达较诱导前明显上调,形态学有典型的DC形态,且均存在Bcr-abl基因带和Ph₁染色体,提示CML-DC为白血病源性。总RNA经脂质体转染CML-DC、CML肿瘤冻融抗原负载CML-DC、总RNA不经脂质体转染CML-DC、未负载抗原CML-DC分别致敏的CTL及IL-2培养的T淋巴细胞在效：靶比为20∶1时的杀伤效率依次降低。结论CML BMMNC来源的 DC既具有CML白血病源性,又具有DC细胞的特性,能诱导特异性CTL杀伤作用;总RNA经脂质体转染的CML-DC诱导的CTL杀伤性对CML细胞的杀伤作用最强。     

流感疫苗促进髓系白血病骨髓细胞来源树突状细胞的功能

目的: 研究流感疫苗对髓系白血病骨髓源性树突状细胞（dendritic cells,DCs）功能的影响及其机制。方法：分离髓系白血病患者\[急性髓细胞白血病(acute myeloid leukemia, AML)19例, 慢性髓细胞白血病（chronic myeloid leukemia,CML) 8例\]骨髓单个核细胞（mononuclear cell,MNC）,用GMCSF和IL4诱导7 d,获得未成熟白血病DCs,然后加入全病毒灭活流感疫苗（whole inactivated influenza vaccine, WIV）、裂解病毒流感疫苗（split influenza vaccine,SIV）或TNFα继续培养24 h。R显带法分析DCs染色体核型,流式细胞仪检测DCs表型,ELISA法测定DCs培养上清IL12的水平,CCK8法检测DCs诱导的CTL对自体白血病细胞的细胞毒作用。结果：19例AML患者中的15例及8例CML患者的MNC全部成功诱导出DCs。与TNFα刺激的白血病DCs相比,流感疫苗刺激的白血病DCs表面分子（CD80、CD83、CD86、HLADR）表达明显上调（P<005）,培养上清中IL12的分泌水平明显增加（P<0.05）,其诱导的CTL可显著杀伤自体白血病细胞（P<0.05）;WIV刺激的DCs在表型、IL12分泌水平及细胞毒作用方面均较SIV刺激的DCs显著增高（P<0.05）。结论： 流感疫苗促进髓系白血病源DCs表型成熟及IL12的分泌,增强其诱导的CTL对自体白血病细胞的杀伤作用。     

慢性粒细胞性白血病瘤苗的研究

慢性粒细胞性白血病（GML)是一种致死性的骨髓增殖异常性疾病,其特征是存在特异性染色体异位,形成BCR-ABL融合基因,编码异常的融合蛋白P210^BCR-ABL。自体骨髓移植和干扰素治疗仅能延长CML患的生存期,迄今治愈CML的最有效的方法是异基因造血干细胞移植(Allo-SCT)。然而由于受干细胞来源及患年龄等因素限制,仅有少部分患能进行此治疗。目前,人们越来越重视免疫治疗、特别是T细胞介导的特异性免疫效应在CML治疗中的作用。异基因T细胞对Allo-SCT后CML复发能产生强力的保护作用;给Allo-SCT后复发的CML患输注同一供的淋巴细胞,可诱导疾病的再次缓解,这是细胞免疫介导的移植物抗白血病(GVL)作用的最直接证据。诱导和提高特异性T细胞免疫反应是根治CML的方向之一。     

抑制吲哚胺2,3-双加氧酶活性促进慢性粒细胞白血病源树突状细胞的功能

目的:研究吲哚胺2,3-双加氧酶(indoleamine 2,3-dioxygenase,IDO)在慢性粒细胞性白血病源性树突状细胞(dendritic cells derived from chronic myeloid leukemia,CML-DCs)中的表达,及抑制IDO活性对CML-DCs免疫刺激功能的影响.方法:RT-PCR检测17例患者CML-DCs的IDO mRNA的表达情况,流式细胞仪检测CML-DCs免疫表型.在有或无IDO抑制剂1-甲基色氨酸(1-methyltroptophan,1-MT)作用下,分别以不成熟CML-DCs(imDCs)和成熟CML-DCs(mDCs)为刺激细胞,完全缓解期(complete remission,CR)CML患者外周T淋巴细胞为反应细胞建立混合淋巴细胞反应体系,ELISA法检测CML-DCs上清液IL-12水平,MTT法检测CML-DCs刺激自体T淋巴细胞的增殖能力.结果:随着CML-DCs的诱导分化和成熟,IDO mRNA表达逐渐上调;经TNF-α诱导的DCs免疫表型除CD1a外,CD80、CD86、CD83、HLA-DR的表达均明显上调(P<0.05),且上述分子的表达不受1-MT的影响.用1-MT抑制IDO活性后的imDCs和mDCs,其IL-12水平均明显增加(P<0.05,P<0.01),且激发自体T淋巴细胞增殖的能力也明显增强(P<0.05,P<0.01).结论:抑制IDO活性可提高CML-DCs的IL-12分泌水平,增强其对自体T细胞增殖的刺激能力,IDO对DCs的负性调节为白血病生物治疗提供了新的思路.     

IFN-α对CML树突状细胞表型及功能的影响

临床观察表明IFN-α治疗早期慢性期CML患者有效,并且IFN-α治疗CML达到部分细胞遗传学缓解以上的患者较之IFN-α治疗无效者其生存期明显延长.IFN-α治疗CML有效的机制尚不清楚,可能与其增强DC的表型及功能有关.DC是体内唯一能激活初始型T细胞的抗原递呈细胞,在机体免疫系统中处于中心地位.我们采用CML患者骨髓单个核细胞,体外有血清培养体系中观察IFN-α对CML-DCs的分化及其功能的影响.     

抑制吲哚胺2，3-双加氧酶活性促进慢性粒细胞白血病源树突状细胞的功能

目的: 研究吲哚胺2,3双加氧酶（indoleamine 2,3dioxygenase,IDO）在慢性粒细胞性白血病源性树突状细胞（dendritic cells derived from chronic myeloid leukemia,CMLDCs）中的表达,及抑制IDO活性对CMLDCs免疫刺激功能的影响。方法: RTPCR检测17例患者CMLDCs的IDO mRNA的表达情况,流式细胞仪检测CMLDCs免疫表型。在有或无IDO抑制剂1甲基色氨酸（1methyltroptophan,1MT）作用下,分别以不成熟CMLDCs（imDCs）和成熟CMLDCs（mDCs）为刺激细胞,完全缓解期（complete remission,CR）CML患者外周T淋巴细胞为反应细胞建立混合淋巴细胞反应体系,ELISA法检测CMLDCs上清液IL12水平,MTT法检测CMLDCs刺激自体T淋巴细胞的增殖能力。结果: 随着CMLDCs的诱导分化和成熟,IDO mRNA表达逐渐上调;经TNFα诱导的DCs免疫表型除CD1a外,CD80、CD86、CD83、HLADR的表达均明显上调(P<005),且上述分子的表达不受1MT的影响。用1MT抑制IDO活性后的imDCs和mDCs,其IL12水平均明显增加(P<005,P<001),且激发自体T淋巴细胞增殖的能力也明显增强(P<0.05,P<0.01)。结论: 抑制IDO活性可提高CMLDCs的IL12分泌水平,增强其对自体T细胞增殖的刺激能力,IDO对DCs的负性调节为白血病生物治疗提供了新的思路。     

慢性粒细胞白血病伴戈谢细胞增多一例

患者男性,45岁,2004年7月21日因发现白细胞高18年就诊。患者18年前因皮肤感染迁延不愈,外院查血常规示白细胞高于40×109/L,血小板和红细胞具体数值不详,骨髓细胞检查示:骨髓有核细胞增生极度活跃,粒∶红=6.5∶1,粒细胞系占0.775,NAP:阴性,考虑为慢性粒细胞白血病(CML),给予白消安、靛玉红交替服用,白细胞控制在10×109/L以下。于1997年10月复查骨髓细胞示:骨髓有核细胞增生明显活跃,粒∶红=5.4∶1,粒系明显增生,占0.76,中幼粒比值明显增高,杆状核粒细胞胞体增大,其他细胞形态大致正常;红细胞系增生偏低,全片见巨核细胞7个,后改用羟基脲…     

α-干扰素与慢性髓性白血病来源的树突状细胞

 各种临床观察肯定了α-干扰素（IFN-α）治疗慢性髓性白血病的疗效,其可明显延长白血病的慢性期及患者生存时间。树突状细胞（DC）作为功能最强的专职抗原递呈细胞,能有效递呈白血病抗原,逆转机体对白血病抗原的耐受,启动特异抗白血病的T细胞应答。IFN-α用于诱导慢性髓性白血病来源的DC,已经取得一定成绩,用IFN-α诱导慢性髓性白血病细胞分化成为具有较强功能的"临床型"DC被寄予厚望。     

树突状细胞疫苗与慢性粒细胞白血病

树突状细胞(DC)是体内最重要的抗原提呈细胞,在抗肿瘤免疫中起着重要的作用。慢性粒细胞白血病(CML)是起源于多能造血干细胞恶性克隆性疾病,负载CML的肿瘤细胞可溶性抗原、bcr/abl抗原肽于DC形成DC疫苗,在体外诱导出抗CML细胞毒作用,用于清除微小残留病。现综述DC疫苗在CML免疫治疗的研究进展。     

Decreased frequency,but normal functional integrity of mesenchymal stromal cells derived from untreated and Imatinib-treated chronic myeloid leukemia patients

In vitro, Imatinib inhibits the proliferation and stimulates the osteogenic and adipogenic differentiation of mesenchymal stromal cells (MSC). However, it is unknown whether Imatinib affects the biology of MSC in vivo. We asked whether MSC from long-term Imatinib-treated CML patients were affected by the in vivo treatment. MSC from untreated and Imatinib-treated patients displayed normal functional properties (i.e. proliferation, immunophenotype, differentiation and hematopoietic supportive capacity) – but a decreased frequency. In vitro, Imatinib lost its effect when discontinued; which suggest that it has a reversible effect on MSC. Therefore it might lose its effect on MSC after discontinuation in vivo.     

p21 Confers resistance to imatinib in human chronic myeloid leukemia cells

Imatinib is a Bcr-Abl inhibitor used as first-line therapy of chronic myeloid leukemia (CML). p21^Cip1, initially described as a cell cycle inhibitor, also protects from apoptosis in some models. We describe that imatinib down-regulates p21^Cip1 expression in CML cells. Using K562 cells with inducible p21 expression and transient transfections we found that p21 confers partial resistance to imatinib-induced apoptosis. This protection is not related to the G2-arrest provoked by p21, a decrease in the imatinib activity against Bcr-Abl or a cytoplasmic localization of p21. The results suggest an involvement of p21^Cip1 in the response to imatinib in CML.     

Total body irradiation in chronic myeloid leukemia

Total body irradiation (TBI), given as 10 rad daily for five days a week for a total dose of 150 rad has been used in an attempt to control the chronic phase of chronic myeloid leukemia (CML). Thirteen patients with CML received fractionated TBI leading to rapid and good control of WBC count without any adverse reaction. The chronic phase of CML could also be controlled with TBI, even in three patients who were resistant to busulfan. Following TBI, WBC count remained under control for a period of 32 weeks as compared to 40 weeks following busulfan alone. Repeat TBI was also well tolerated with good response. It appears that TBI is an effective and safe therapy for controlling the chronic phase of CML.     

An approach to the management of chronic myeloid leukemia in British Columbia

Chronic myeloid leukemia (cml) is a myeloproliferative disorder whose therapy has changed dramatically since the late 1990s. With the introduction of the tyrosine kinase inhibitor (tki) imatinib mesylate, the treatment outcomes for patients with cml have improved markedly, and hematopoietic stem-cell transplantation is no longer routinely offered as first-line therapy for most patients in chronic phase.However, resistance to tki therapy is increasingly being recognized, and alternative therapy is needed for this group of patients. In addition, the development of models predicting response to tki therapy is desired, so that appropriate treatment strategies can be used for individual patients. The present report serves to outline the approach to the treatment of cml in British Columbia and to highlight areas of ongoing research.     

慢性髓系白血病急变期中免疫分型研究

 目的 探讨慢性髓系白血病急变期（CML-BC）的免疫表型特征及应用价值。方法 采用一组单克隆抗体和三色流式细胞术对36例成年人CML-BC骨髓标本进行免疫表型分析。结果 36例CML-BC患者中急性非淋巴细胞白血病变30例（83.33 %）,其中40 %（12／30）伴淋系表达;急性淋巴细胞白血病变急淋变3例（8.33 %）,其中66.67 %（2／3）伴髓系表达;急性混合型白血病变2例;急性未分化型白血病变1例。CML-BC以CD33阳性率最高91.67 %,其次是CD+13 86.11 %,CD+34 61.11 %,CD+7 33.33 %,CD+10 19.44 %,CD+19 16.67 %,CD+2 2.78 %,CD+20 5.56 %及CD+14 5.56 %。CD7与CD34共阳性27.78 %。结论 CML-BC免疫表型复杂,多系表达常见。免疫分型可协助判断CML的急变类型。     

Extramedullary blast crisis in chronic myeloid leukemia

Among 235 patients with CML we reviewed 91 patients with BC diagnosed between 1980 and 1995; 15 of the 91 (16%) developed extramedullary disease (EMD). The sites involved were the lymph nodes (13/15), CNS (1/15) and suborbital mass (1/15). The appearance of EMD was associated with chronic phase (CP) features in the bone marrow in 3/15 cases, with accelerated phase (AP) in 3/15 and with BC in 9/15. 11/15 (73%) cases of EMD were classified as myeloid (My-EMD) and 4/15 as lymphoid-type (Ly-EMD): three B-phenotype and one T-phenotype. All Ly-EMD cases were treated with vincristine, daunorubicin and prednisone and obtained complete remission (CR). Cases of My-EMD were treated with daunorubicin and cytosine arabinoside, of which only 1/11 achieved CR. We suggest that in EMD also, the type, lymphoid or myeloid, of BC has a bearing on treatment response and prognosis: Ly-EMD is more responsive to treatment and has longer survival than My-EMD.     

Requirement of lipocalin 2 for chronic myeloid leukemia

The Bcr-Abl oncoprotein causes chronic myeloid leukemia by a mechanism involving its activated tyrosine kinase. BCR-ABL+ mouse hematopoietic cells persistently express and secrete lipocalin 2 by a mechanism that requires the tyrosine kinase of the Bcr-Abl oncoprotein. Our new findings indicate that lipocalin 2 is required for leukemia induction, as prevention of expression of lipocalin 2 by BCR-ABL+ mouse marrow cells totally blocks leukemia induction in a mouse model.     

Non-random clonal evolution in 45 cases of chronic myeloid leukemia.

Chromosome analyses, using for the most part the RHG-banding technique, were performed on blood and bone marrow of 52 patients with chronic myeloid leukemia (CML) during blastic crisis. In 16 of these patients studies were also done on spleen and/or on lymph nodes.In 45 of our patients other chromosomal aberrations in addition to the Ph¹ were found. Our studies demonstrated that the chromosomal involvement in the development of malignancy in CML is not a random event. A second Ph¹ chromosome was found in 28 patients (62.2%). An additional long arm of chromosome 17 [trisomy 17 or i(17q)] was seen in 29 patients (64.4%) and a trisomy 8 in 13 patients (28.8%). These three main abberrations occurred alone or together in the same cell. We have seen 13 patients (28.8%) with 2 Ph¹ and trisomy 17q without trisomy 8.Karyotypic evolution usually proceeds by addition of chromosomes.