负载U937细胞冻融抗原的DC诱导CTL的特异性杀伤

树突状细胞 (DC)作为重要的专职抗原提呈细胞 ,其抗原提呈能力远强于巨噬细胞和B细胞等抗原提呈细胞。因而 ,以DC为中心的免疫治疗是肿瘤生物学治疗的主要方向之一。我们应用当前普遍采用的rhGM CSF、rhIL 4培养体系 ,自骨髓单个核细胞诱导产生CD14 - CD1a 的前体DC ,使其负载     

两种白血病细胞抗原负载DC的体外诱导特异性CTL应答的比较

目的: 比较树突状细胞 (DC)与白血病细胞融合及白血病细胞冻融抗原负载DC两种白血病DC疫苗诱导抗原特异性CTL应答的能力。方法: 采用羟乙基淀粉 Ficoll两步法分离外周血单个核细胞(PBMC), 通过贴壁 2h获得黏附的单核细胞, 用GM- CSF加IL- 4诱导培养 5d收获细胞。将细胞分为 4组: A组将K562细胞或原代慢性粒细胞白血病(CML)细胞在 500g/LPEG 100mL/LDMSO诱导下与DC融合; B组加入相应细胞数量的白血病细胞冻融抗原; C组将K562细胞或CML细胞与DC共培养; D组: 单独DC培养组。融合前以红色荧光染料PKH26标记K562细胞, 采用流式细胞仪(FCM)检测PKH26 /FITC 抗HLA ABC抗体双标细胞并评估融合率。培养的第 6天, 加入TNF -α诱导DC成熟, 然后分别与自体T细胞共培养, 用MTT比色法检测各组CTL对靶细胞的杀伤活性。结果: GM- CSF加IL -4和TNF- α依次诱导成熟的DC具有经典的DC的形态和表型特征, 在PEG -DMSO的介导下, DC与白血病细胞的融合率为 ( 17. 33 ~29. 94 )%。两种抗原负载方案激活的CTL均对表达K562抗原的细胞具有特异性的细胞毒作用。在效靶比相同时, 融合组诱导CTL的杀伤活性强于冻融抗原致敏DC组。结论: 与冻融抗原致敏的DC相比, DC与白血病细胞融合细胞递呈抗原的效率更高, 体外诱导的CTL特异性杀伤靶     

卵巢癌细胞株冻融抗原负载的树突状细胞诱导CTL抗卵巢癌免疫应答的体外研究

目的研究卵巢癌冻融抗原负载的树突状细胞(dendriticcells,DC)诱导细胞毒性T淋巴细胞(CTL)体外杀伤卵巢癌细胞的细胞毒性效应。方法利用免疫磁珠分离法(MACS)分离纯化脐血CD34 细胞并在体外诱导分化为DC,用反复冻融法从卵巢癌细胞系SKOV3中提取的可溶性相关抗原负载DC。流式细胞学检测负载抗原后DC表面各种分化相关抗原的表达,ELISA法检测DC上清中IL12的表达,混合淋巴细胞反应(MLR)测定DC体外刺激T细胞增殖的能力,MTT法检测抗原负载DC激活的抗原特异性CTL对卵巢癌细胞的杀伤作用。结果与未经抗原负载的DC相比,经卵巢癌抗原负载的DC不仅能更高地表达各种DC分化相关抗原CD1α(73.35%±2.94%vs34.1%±2.35%)、CD83(73.9%±8.46%vs54.68%±3.26%)、CD80(91.95%±2.48%vs52.53%±3.18%)、HLADR(70.05%±2.35%vs48.7%±2.07%)以及CD54(88.9%±5.52%vs71.45%±2.29%),同时具有更强的刺激同种异体T淋巴细胞增殖和IL12分泌的能力(P均<0.05)。此外,卵巢癌细胞SKOV3冻融抗原负载DC激活的CTL在体外对SKOV3的杀伤率为77.35%,显著高于未经抗原负载的DC(P=0.0001)。结论经卵巢癌细胞冻融抗原负载DC激活的CTL在体外具有更强的增殖能力和杀伤卵巢癌细胞的作用。     

负载甘露糖化抗原的DC诱导的特异性杀伤

目的：探讨甘露糖化肿瘤疫苗在抗肿瘤免疫中的作用。方法：纯化出目的蛋白HER-2／neu胞外配体第2结构域（RLD2），并对其进行糖基化修饰，自外周血单核细胞诱导产生CD83^＋的DC，利用DC表面的甘露糖受体，使DC负载甘露糖基化的目的抗原mRLD2（mL2），并致敏T淋巴细胞，观察CTL特异性杀伤SKBR-3细胞的效果。结果：较之未进行糖基化修饰的目的蛋白RLD2（T2），mL2能促进DC的成熟，并能诱导出具有更强杀伤效力的CTL。结论：本实验的结果为开展新型甘露糖化肿瘤疫苗的研制提供了理论依据。     

树突状细胞负载肝癌抗原肽疫苗体外诱导特异性免疫学反应的研究

目的：研究树突状细胞(dendritic cell，DC)负载肝癌抗原肽EPVTKAEML体外诱导特异性CTL的能力及其抑癌效果。方法：用顺序特异引物聚合酶链反应技术(PCR—SSP)选择HLA—B7表型供者，从脾组织中分离、培养DC-EPVTKAEML特异性CTL。用^51Cr释放法检测CTL的杀伤活性，并用抗HLA-1分子单抗(mAb)进行杀伤抑制实验。结果：找到4例HLA-B7杂合子供者，用DC负载HLA-B7限制的抗原肽EPVTKAEML可诱导特异性CTL反应，对肝癌细胞HHCC有较强的杀伤作用。结论：DC负载抗原肽EPVTKAEML在体外可诱发较强的特异性免疫反应。     

钙载体诱导慢性髓系白血病细胞分化成树突状细胞

目的：探讨用钙离子载体（Calcium ionorphore，CI）A23187诱导慢性髓系白血病（CML）病人来源的白血病细胞分化成树突状细胞（Dendritic cells，DCs）的方法和条件。方法：选择外周血白细胞计数较高的CML病人，采集外周血或骨髓液分离单个核细胞，通过两次贴壁法除去单核细胞和淋巴细胞，然后放入含或不含GM-CSF（200ng／ml）和CI（375ng／ml）的RP-M11640培养液中培养96小时以上，通过流式细胞仪分析细胞表型、倒置显微镜和电镜观察细胞的形态变化来观察CI对白血病细胞诱导成树突状细胞的作用，初步摸索和探讨CI诱导白血病细胞转化成树突状细胞的最佳条件。结果：发现对CML病人外周血或骨髓液分离的白血病细胞加入GM—CSF（200ng／ml）、CI（375ng／ml）和含10％胎牛血清的RPMI1640培养96小时，细胞能获得典型的成熟树突状细胞的形态，CD86、CD80、CD40、CD83和HLA-DR的表达显著提高。结论：CML细胞用GM-CSF和CI联合诱导能获得成熟树突状细胞的典型形态特征和免疫表型。     

082 树突状细胞与髓性白血病的免疫治疗研究进展

树突状细胞（ＣＤ）是目前发现的功能最强的抗原提呈细胞（ＡＰＣ）,近年来对ＤＣ的研究成为热点。髓性白血病是一组不同分化程度多克隆的异常髓系增生性疾病。本文拟对ＤＣ应用于髓性白血病免疫治疗方面的研究进展作一综述。     

急性髓系白血病淋系抗原的表达及其意义

<正>自1993年以来,我们用单克隆抗体(McAb)对40例急性髓系白血病(AML)的白血病细胞免疫表型进行了检测.1 材料和方法1.1 病例和标本 40例AML均系我院住院患者,都为初发病例;男性21例,女性19例;年龄13～71岁;按FAB分型标准,M_16例,M_2.9例,M_39例,M_47例,M_5 9例.检测标本多数为化疗开始前抽取的骨髓,少数为外周血.1.2 检测方法 间接免疫荧光法,荧光阳性细胞≥0.20作为阳性指标.实验中采用的McAb有:CD2、CD3、CD4、CD7、CD8、CD10、CD11b、CD13、CD14、CD15、CD19、CD20、CD22、CD33、CD34、CD41b、HLA-DR、μ、SmIg等.McAb分别购自军事医学科学院和中国医学科学院血液学研究所.     

交叉表达髓系和淋系相关抗原急性白血病的免疫学及临床特征研究

交叉表达淋系和髓系相关抗原的急性白血病（AL）包括伴有髓系抗原阳性的急性淋巴细胞性白血病（My^＋ -ALL）、伴有淋系抗原阳性的急性髓细胞性白血病（Ly^＋ -AML）及多系表达（即同时表达T、B及髓系三系以上的抗原）。而多系表达是AL免疫分型中的少见类型，国内外报道甚少。本研究对以上几种类型AL的表达特征及意义做简要分析，以利于今后白血病的诊治。[第一段]     

自体树突状细胞诱导TDLN细胞对胃癌细胞系KATO3的体外杀伤作用

目的：研究用冻融的自体胃癌抗原冲击树突状细胞(DC)来诱导肿瘤引流区淋巴结(TDLN)细胞对胃癌细胞系的体外杀伤作用。方法：采用胃癌患者外周血粘附细胞(PBAC)，经GM-CSF、IL-4、TNF-α诱导和自体肿瘤冻融抗原(Ag)刺激诱生所获得的DC与TDLN细胞1：50比例共培养3天，获得DC激活的TDLN，即DC-TDLN作效应细胞；分别以Ag和培液代替DC同样培养TDLN，即Ag-TDLN和TDLN作对照，对胃癌细胞系KATO3和黑色素瘤细胞系A375进行杀伤。结果：DC-TDLN、Ag-TDLN、TDLN各组细胞对KATO3，均有显著杀伤活性，其中DC-TDLN组的杀伤作用明显优于后两组，且效靶比20：1的杀伤率优于10：1，显示可能有量效关系；而TDLN各组不同效靶比对A375杀伤率则无显著差异。结论：自PBAC获得的DC，经自身肿瘤Ag冲击并与自身TDLN共培养，可使后者对胃癌细胞系细胞的杀伤作用明显增强。     

Clinical Utilization of Chimeric Antigen Receptor T Cells in B Cell Acute Lymphoblastic Leukemia: An Expert Opinion from the European Society for Blood and Marrow Transplantation and the American Society for Blood and Marrow Transplantation

On August 30, 2017 the US Food and Drug Administration approved tisagenlecleucel (Kymriah; Novartis, Basel, Switzerland), a synthetic bioimmune product of anti-CD19 chimeric antigen receptor T cells (CAR-T), for the treatment of children and young adults with relapsed/refractory B cell acute lymphoblastic leukemia (B-ALL). With this new era of personalized cancer immunotherapy, multiple challenges are present, ranging from implementation of a CAR-T program to safe delivery of the drug, long-term toxicity monitoring, and disease assessments. To address these issues experts representing the American Society for Blood and Marrow Transplant, the European Society for Blood and Marrow Transplantation, the International Society of Cell and Gene Therapy, and the Foundation for the Accreditation of Cellular Therapy formed a global CAR-T task force to identify and address key questions pertinent for hematologists and transplant physicians regarding the clinical use of anti CD19 CAR-T therapy in patients with B-ALL. This article presents an initial roadmap for navigating common clinical practice scenarios that will become more prevalent now that the first commercially available CAR-T product for B-ALL has been approved.     

Generation of CD4 and CD8 T Lymphocyte Responses by Dendritic Cells Armed with PSA/Anti-PSA (Antigen/Antibody) Complexes

Dendritic cells (DC) acquire antigens through a number of cell surface structures including receptors for the Fc portion of immunoglobulins and mannose. Little is known about the effects of antigen uptake via these receptors on antigen processing and presentation. We compared the capacity of DC to generate CD4(+) and CD8(+) T cell responses after exposure to prostate-specific antigen (PSA) alone, PSA targeted to the mannose receptor (mannosylated PSA (PSA-m)), or PSA targeted to Fc receptors by combining PSA with an anti-PSA antibody (AR47.47). Autologous CD3(+) T cells were added to monocyte-derived immature DC that had been cultured with GM-CSF/IL-4 for 4 days, exposed to antigen, and matured with CD40L or TNFalpha/IFN-alpha. After several rounds of stimulation, T cell responses were assessed by intracellular IFN-gamma production using flow cytometry. Both CD4(+) and CD8(+) T cell responses were observed after stimulation with DC exposed to the PSA/anti-PSA complexes, whereas CD4(+) predominated over CD8(+) T cell responses after stimulation with PSA-armed DC or PSA-m. These CD8(+) T cells responded when rechallenged with DC pulsed with HLA allele-restricted PSA peptides. These results indicate that PSA and PSA-m are processed primarily through pathways that favor HLA Class II presentation, while the PSA/anti-PSA immune complexes are processed through both Class I and Class II pathways in monocyte-derived DC. These findings have potential applications in designing more effective cancer vaccines for prostate cancer.     

Donor Lymphocyte Infusion for the Treatment of Relapsed Acute Myeloid Leukemia after Allogeneic Hematopoietic Stem Cell Transplantation: A Retrospective Analysis by the Adult Acute Myeloid Leukemia Working Group of the Japan Society for Hematopoietic Cell Transplantation

Because the efficacy of donor lymphocyte infusion (DLI) for acute myeloid leukemia (AML) relapse after allogeneic hematopoietic stem cell transplantation (HSCT) remains uncertain, especially in the Asian population, a nationwide registry study was retrospectively performed by the Adult AML Working Group of the Japan Society for Hematopoietic Cell Transplantation to identify the factors affecting the patient survival after DLI. Among 143 adult AML patients who received DLI for the treatment of first hematological relapse after HSCT, the overall survival rates at 1 year, 2 years, and 5 years were 32% ± 4%, 17% ± 3%, and 7% ± 3%, respectively. Complete remission (CR) at the time of DLI, which was obtained in 8% of the patients, was the strongest predictive factor for survival after DLI. Therefore, long-term survival after DLI was achieved almost exclusively in patients who successfully achieved a CR before DLI, indicating the limited efficacy of DLI in a minority of patients.     

Intravenous Busulfan Compared with Treosulfan-Based Conditioning for Allogeneic Stem Cell Transplantation in Acute Myeloid Leukemia: A Study on Behalf of the Acute Leukemia Working Party of European Society for Blood and Marrow Transplantation

Dose intensity of the conditioning regimen has significant impact on the outcomes after stem cell transplantation (SCT) for acute myeloid leukemia. Most studies have shown more relapse, less nonrelapse mortality (NRM), and similar overall survival after reduced-intensity and myeloablative conditioning. There are limited data on the dose equivalence and expected outcomes of treosulfan-based compared with busulfan-based conditioning. We compared SCT outcomes after fludarabine with either intravenous busulfan at a myeloablative dose (FB4, 12.8?mg/kg, n?=?1265) or a reduced dose (FB2, 6.4?mg/kg, n?=?1456) or treosulfan at 42 g/m² (FT14, n?=?403) or 36 g/m² (FT12, n?=?168). Median patient age was 48, 60, 57, and 60 years in the FB4, FB2, FT14, and FT12 groups, respectively (P?<?.0001). Two-year overall survival was 58%, 53%, 53%, and 51%, respectively (P?=?.25). Multivariate analysis identified advanced age, advanced disease status, and secondary leukemia to be associated with worse survival. Relapse rate was 30%, 35%, 34%, and 40%, respectively. Relapse was more common after FB2, advanced age and disease status, secondary leukemia, and sibling donors. NRM was 17%, 18%, 21%, and 16%, respectively. NRM was least common after FT12 and more common with advanced age and disease status and unrelated donors. Treosulfan-based regimens were associated with lower rates of graft-versus-host disease. There was no difference in any outcome among patients in first complete remission at transplantation. However, there was better survival with treosulfan-based conditioning in advanced leukemia. In conclusion, survival is determined mostly by disease biology and is similar after various regimens. Treosulfan-based conditioning is more similar to myeloablative than to reduced-intensity conditioning but can be administered safely in older patients, with lower rates of graft-versus-host disease and possibly better outcomes in patients with active leukemia.     

Reversal of T Cell Exhaustion by the First Donor Lymphocyte Infusion Is Associated with the Persistently Effective Antileukemic Responses in Patients with Relapsed AML after Allo-HSCT

Donor lymphocyte infusion (DLI) is an effective approach to treat acute myelogenous leukemia (AML) relapse after allogeneic hematopoietic stem cell transplantation (allo-HSCT) that significantly improves the survival of relapsed patients. However, the mechanism of an effective antileukemic response following DLI in AML relapse remains elusive. Here, we investigated the role of T cell exhaustion in AML relapse after allo-HSCT in prospective cohorts of 41 patients with the first AML relapse and 41 nonrelapsed AML control subjects after allo-HSCT and determined whether DLI exerts effective antileukemic effects by reversing T cell exhaustion in the relapsed cohorts by detecting the phenotypes and functions of T cells using flow cytometry. We found that both CD4⁺?and CD8⁺?T cells experienced exhaustion with upregulated coexpression of PD-1 and Tim-3, and functional impairments in cytokine production, proliferation, and cytotoxic potentials. The reversal of T cell exhaustion by the first DLI is associated with persistent complete remission in relapsed AML patients. In addition, the reversal of T cell–exhausted status after successful DLI in bone marrow was concurrent with the mitigated inversion of CD4/CD8 T cell ratio. In conclusion, our study shows a clinical correlation between T cell exhaustion and AML relapse after allo-HSCT, and uncovers the role of reversing T cell exhaustion in the antileukemic response by DLI and identifies possible immunological markers to evaluate and predict the graft-versus-leukemia effects induced by DLI.     

Study on the Cytotoxic T Lymphocytes Clone Specific for the Nucleocapsid Protein of Hantaan Virus from Peripheral Blood in Patients with Hemorrhagic Fever with Renal Syndrome

Hemorrhagic fever with renal syndrome (HFRS) occursmainly in China with a high mortality rate and threatensthe health and life of population, Hantaan virus (HTNV),the prototype member of Hantavirus (HV) genus, causesHFRS in human. In the structural proteins of HV, the nu cleocapsid protein (NP), is associated with the functionsof viral RNA, and is also an important immunogen involv ing in the protective immune responses against infection.The pathogenesis of Hantaan virus infecti…     

Impact on Outcomes of Human Leukocyte Antigen Matching by Allele-Level Typing in Adults with Acute Myeloid Leukemia Undergoing Umbilical Cord Blood Transplantation

This retrospective study analyzed the impact of directional donor-recipient human leukocyte antigen (HLA) disparity using allele-level typing at HLA-A, -B, -C, and -DRB1 in 79 adults with acute myeloid leukemia (AML) who received single-unit umbilical cord blood (UCB) transplant at a single institution. With extended high-resolution HLA typing, the donor-recipient compatibility ranged from 2/8 to 8/8. HLA disparity showed no negative impact on nonrelapse mortality (NRM), graft-versus-host (GVH) disease or engraftment. Considering disparities in the GVH direction, the 5-year cumulative incidence of relapse was 44% and 22% for patients receiving an UCB unit matched ≥ 6/8 and < 6/8, respectively (P = .04). In multivariable analysis, a higher HLA disparity in the GVH direction using extended high-resolution typing (Risk ratio [RR] 2.8; 95% confidence interval [CI], 1.5 to 5.1; P = .0009) and first complete remission at time of transplantation (RR 2.1; 95% CI, 1.2 to 3.8; P = .01) were the only variables significantly associated with an improved disease-free survival. In conclusion, we found that in adults with AML undergoing single-unit UCBT, an increased number of HLA disparities at allele-level typing improved disease-free survival by decreasing the relapse rate without a negative effect on NRM.     

American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group Survey on Chimeric Antigen Receptor T Cell Therapy Administrative,Logistic, and Toxicity Management Practices in the United States

Administration of immune effector cell (IEC) therapy is a complex endeavor requiring extensive coordination and communication of various healthcare and administrative teams. Chimeric antigen receptor (CAR) T cells are the most established IEC therapy available. As of July 2018 two commercial gene therapy products, tisagenlecleucel and axicabtagene ciloleucel, have been approved by the US Food and Drug Administration. To gain insight into the infrastructure and practices across the country, the American Society for Blood and Marrow Transplantation Pharmacy Special Interest Group conducted an electronic survey on the current administrative, logistic, and toxicity management practices of CAR T cell therapy across the United States. This survey consists of 52 responses from institutions of varying sizes, most of which (～80%) had previous investigational experience with CAR T cell therapy. Absorbing the energy of this exciting new treatment has challenged hematopoietic cell transplant programs across the country to strengthen department infrastructure, develop new committees and policies, and implement significant education to ensure safe administration. With the variety of experience with CAR T cell therapy, we hope this survey can contribute to the existing published literature and provide support and consensus to established and developing IEC programs and practice guidelines.     

Allogeneic Hematopoietic Cell Transplantation May Alleviate the Negative Prognostic Impact of Monosomal and Complex Karyotypes on Patients with Acute Myeloid Leukemia

Monosomal karyotype (MK) and complex karyotype (CK) are well known to be associated with a very poor clinical outcome in patients with acute myeloid leukemia (AML). However, whether or not the prognostic impact of MK and CK remains relevant for patients who have undergone allogeneic hematopoietic cell transplantation (allo-HCT) is still unclear. We retrospectively analyzed the status of MK and CK, as well as other clinical laboratory features, in 148 allo-HCT AML patients at our institution and correlated with their event-free survival (EFS) and overall survival (OS) after transplantation. MK and CK were identified in 14 (9%) and 19 (13%) cases, respectively. On univariate analysis, only age (≥60 years) and WBC count (≥15 × 10⁹/L) were significant adverse predictors for EFS (P < .001 and P = .017, respectively) and OS (P = .002 and P = .021, respectively). MK, CK, and other relevant parameters analyzed did not affect the clinical outcome. Multivariable analysis confirmed that both older age and high WBC count were independent prognostic factors for a shorter OS (P = .001 and P = .003, respectively) and a shorter EFS (P < .001 and P = .001, respectively). Our results indicate that neither MK nor CK are high-risk factors in AML patients undergoing allo-HCT.     

Protective Effect of Cytomegalovirus Reactivation on Relapse after Allogeneic Hematopoietic Cell Transplantation in Acute Myeloid Leukemia Patients Is Influenced by Conditioning Regimen

Cytomegalovirus (CMV) reactivation after allogeneic hematopoietic cell transplant (allo-HCT) has been associated with a reduced risk of relapse in patients with acute myeloid leukemia (AML). However, the influence of the conditioning regimen on this protective effect of CMV reactivation after allo-HCT is relatively unexplored. To address this, we evaluated the risk of relapse in 264 AML patients who received T cell–replete, 6/6 HLA matched sibling or 10/10 HLA matched unrelated donor transplantation at a single institution between 2006 and 2011. Of these 264 patients, 206 received myeloablative (MA) and 58 received reduced-intensity conditioning (RIC) regimens. CMV reactivation was observed in 88 patients with MA conditioning and 37 patients with RIC. At a median follow-up of 299 days, CMV reactivation was associated with significantly lower risk of relapse in patients who received MA conditioning both in univariate (P = .01) and multivariate analyses (hazard ratio, .5246; P = .006); however, CMV reactivation did not significantly affect the risk of relapse in our RIC cohort. These results confirm the protective effect of CMV reactivation on relapse in AML patients after allo-HCT reported by previous studies but suggest this protective effect of CMV reactivation on relapse is influenced by the conditioning regimen used with the transplant.