骨髓移植后的免疫治疗

目的：研究免疫治疗用于治疗及预防骨髓移植（ｂｏｎｅ ｍａｒｒｏｗ ｔｒａｎｓｐｌａｎｔａｔｉｏｎ ，ＢＭＴ） 后的白血病复发。方法：Ａ组为异基因骨髓移植（ＡｌｌｏＢＭＴ） 后白血病复发患者１０ 例，接受供者白细胞治疗。Ｂ组为自身外周血干细胞移植（ａｕｔｏｇｅｎｏｕｓｐｅｒｉｐｈｅｒａｌｂｌｏｏｄ ｓｔｅｍ ｃｅｌｌｓｔｒａｎｓｐｌａｎｔａｔｉｏｎ，ＡＰＢＳＣＴ）或ＢＭＴ后共１０ 例患者输注免疫杀伤细胞（ｃｙｔｏｋｉｎｅｉｎｄｕｃｅｄ ｋｉｌｌｅｒ，ＣＩＫ）细胞治疗。结果：Ａ 组患者中血液学复发的６ 例，１ 例Ｐｈ１ 染色体１００％ 转阴，无病存活至今已超过１８ 个月，４ 例达暂时缓解；１ 例未缓解；微小残留及中枢神经系统复发共４ 例，均完全缓解，其中Ｐｈ１ 染色体全部转阴。Ｂ组１０ 例中１ 例患者带有的白血病融合基因转阴。结论：（１） 供者白细胞的输注能使某些ＢＭＴ后慢性粒细胞性白血病遗传学及血液学复发患者完全缓解。（２）ＣＩＫ 细胞输注是安全的，对某些白血病复发患者的治疗是有效的。

Immunotherapy after bone marrow transplantation

Objective: To study immunotherapy for leukemia relapse and prophylaxis after bone marrow transplantation(BMT). Methods: In group A, 10 cases of leukemia relapse after Allo BMT were treated with concentrated mononuclear cells from the marrow donor. In group B, 10 cases of leukemia after APBSCT (autogenous peripheral blood stem cells transplantation) or BMT were treated with CIK (cytokine induced killer) cells. Results: Among 6 patients with hematological relapse in group A, one patient has being living well for 18 months with disappearance of the Ph 1 chromosome. 4 patients showed temporary remission and then relapsed again. One patient showed no response. The other 4 patients (2 with CNS relapse and 2 patients with relapse of minimal residual disease) showed remission, and remained Ph 1 chromosome negative. In group B, a patient treated with CIK cells with a special leukemia infused gene (AML/ETO) turned negative after one treatment of CIK cells. Conclusion: (1) Donor derived leukocyte infusion can induce CML post BMT to cytogenetic and hematological CR. It has also therapeutic effects on acute leukemia relapse but is less sustained. (2) CIK cells can be safely infused into patients and is effective in the therapy of leukemia relapse at least in some patients.