急性白血病免疫治疗的研究现况和前景

要进一步延长急性白血病治疗后缓解期和消灭残余微量白血病细胞，重要方法之一是开展免疫治疗。在研究中的免疫治疗方法有4种：D单克隆抗体(单抗)，其中Mylotarg(抗CD33单抗接上细胞毒抗生素利东霉素)用于治疗复发和难治急性髓性白血病(AML)及急性早幼粒细胞白血病(APL)分子复发，取得良好效果；Campath—1H(抗CD52单抗)治疗幼淋细胞白血病(PLL)，美罗华治疗B—PLL，缓解率高。其他研究的单抗尚有IL-22单抗治疗急性T细胞白血病、抗220KD单抗6G7治疗急性白血痛、重组免疫毒素BL22(抗CD22)治疗毛细胞白血病以及一些用同位素标记的单抗治疗各种急性白血病；②过继性细胞免疫治疗，用细胞因子诱导的杀伤细胞、同种反应NK细胞、同种或自身白血病特异的CD8^ 细胞毒T淋巴细胞和其他免疫效应细胞；⑧细胞因子及其他免疫调节剂，诸如IL-2，IL-12，GM—CSF，CD40L,LT-3L，沙利度胺及其衍化物；④白血病疫苗，有抗原特异的、白血病细胞为基础的、负载白血病抗原的树突状细胞(DC)和白血病来源的DC疫苗等几种不同剂型，以后两者剂型更受重视。总之，到目前为止，急性白血病免疫治疗中最有效的方法是应用单抗，其他大多数方法也已显示应用前景，值得进一步研究.

Present Status in Studying Immunotherapy for Acute Leukemia and Its Perspective--Editorial

One of the important approaches for further prolonging remission duration and eradicating minimal residual disease in acute leukemia is immunotherapy. Four kinds of immunotherapy for acute leukemia are under investigation: (1) monoclonal antibodies, among them, Mylotarg (cytotoxic antibiotic calicheamicin linked to CD33 Mab) is given for the treatment of refractory or relapsed acute myeloid leukemia and molecular relapse in acute promyelocytic leukemia with good results, Campath-1H(antiCD52 Mab) is administered in the treatment of prolymphocytic leukemia and Rituximab(anti-CD20 Mab) in B-PLL with high complete remission rates. Other Mabs under preclinical and clinical trials include anti-IL-2 receptor Mab for the treatment of acute T lymphocytic leukemia, anti-220 kD Mab-6G7 for acute leukemias, recombinant immune toxin BL22(anti-CD22) for hairy cell leukemia and Mabs labeled with radio-isotopes for different types of acute leukemias;(2)adoptive cellular immunotherapy using cytokine-induced killer cell, alloreactive NK cells, allogeneic or au-tologous leukemic-specific CD8 cytotoxic T lymphocytes, and other immune effector cells; (3)cytokines and other immune modulators comprising IL-2, IL-12, GM-CSF, CD40L, FLT-3L and thalidomide and its derivatives; (4)leukemia vaccines of several different formulations including antigen-specific, leukemia cell-based, leukemia antigen-pulsed dendritic cell (DC) and leukemia-derived DC vaccines, the latter two formulations are more attractive. In conclusion, up to now, the most effective example of immunotherapy in acute leukemia is provided by the administration of Mabs, and the majority of other approaches in immunotherapy for acute leukemia although promising, need further studies.