异基因造血干细胞移植后供者外周血造血干细胞输注预防高危白血病复发

目的评估重组人粒细胞集落刺激因子(G-CSF)动员的供者外周血造血干细胞输注 (GPBSCI)作为一种早期过继性免疫治疗方法的有效性和安全性。方法 12例高危白血病患者同胞配型相合异基因造血干细胞移植(allo-HSCT)后接受了G-CSF动员的预防性GPBSCI。allo-HSCT前患者的诊断包括2例Ph 急性淋巴细胞白血病首次完全缓解(ALL-CR1),1例ALL-CR2,1例ALL合并顽固中枢神经系统白血病(CNSL),1例急性髓系白血病(AML)复发,1例AML合并CNSL,1例 AML-CR3,4例进展期慢性粒细胞白血病(CML)及1例骨髓增生异常综合征-难治性贫血伴幼稚细胞增多型(MDS-RAEB)。结果 12例患者共接受了16次GPBSCI,其中移植后90天( 90天)前接受 GPBSCI 5次,输注的单个核细胞(MNC)及CD3 细胞中位数分别为1．00(0．95-1．24)×108/kg和 0．53(0．39-0．63)×108/kg。 90天后接受GPBSCI 11次,输注两类细胞中位数分别为2．27(1．00- 4．30)×108/kg和1．15(0．55-2．10)×108/kg。输注后4例患者发生了Ⅰ或Ⅱ度急性移植物抗宿主病(GVHD),1例患者发生Ⅲ度急性GVHD。7例患者发生了慢性GVHD,其中4例为广泛型。2例患者未发生输注相关GVHD。未观察到GPBSCI相关的全血细胞减少。中位随访563(415-728)d,12 例高危白血病患者中有10例无病存活,2例死于白血病复发。结论预防性GPBSCI可以增强移植物抗白血病作用,相关不良反应小,可能成为改善高危白血病allo-HSCT预后的安全有效的手段。

Donor peripheral hematopoietic stem cells infusion for prophylaxis of relapse of high risk leukemia after allogeneic hematopoietic stem cell transplantation

OBJECTIVE: To study the effect of growth factor-primed donor hematopoietic stem cells infusion (GPBSCI) as an early adoptive immunotherapy. METHODS: Twelve patients with high-risk leukemia received prophylactic GPBSCI after allogeneic hematopoietic stem cell transplantation (allo-HSCT). Out of the 12 patients, two were Ph(+) ALL in CR(1), one ALL in CR(2), one refractory ALL, three AML (one in relapse, one refractory disease, one in CR(3)), four CML in advanced stage and one myelodysplastic syndrome-refractory anemia with excess blast (MDS-RAEB). RESULTS: Sixteen infusions were performed in the 12 patients, including 5 infusions were performed within +90 days post-SCT. The median mononuclear cells (MNC) and CD3(+) cells infused for GPBSCI before +90 d were 1.00 (0.95 - 1.24) x 10(8)/kg and 0.53 (0.39 - 0.63) x 10(8)/kg, and after +90 d were 2.27 (1.00 - 4.30) x 10(8)/kg and 1.15 (0.55 - 2.10) x 10(8)/kg, respectively. Four patients developed grade I - II acute GVHD, and one grade III acute GVHD. Seven patients developed chronic GVHD, of which four cases were extensive. Two patients had no transfusion related GVHD. No transfusion related pancytopenia was observed. Ten patients survived disease-freely at 563 (415 - 728) days of follow-up. Two patients died of leukemia relapse after GPBSCI. CONCLUSION: Allo-HSCT with prophylactic GPBSCI could maximize graft-versus-leukemia effect with few fatal complications and might be a potentially curative strategy for hematological malignancy patients with high risk of relapse.