Keil F, Kalhs P, Chen X, Haas O A, Fritsch G, Chott A, Lechner K, Moser K, Ackermann J, Rabitsch W, Worel N, Mannhalter C, Greinix H T
Department of Medicine 1, Bone Marrow Transplantation Unit, University of Vienna, Austria.
Ann Hematol. 1999 Aug;78(8):376-9. doi: 10.1007/s002770050532.
A large group of patients relapsing after allogeneic bone marrow transplantation (BMT) have obtained remission after infusion of leukocytes from their original donor, suggesting a graft-versus-myeloma effect. However, side effects such as graft-versus-host disease and myelosuppression are severe, and sometimes fatal, complications of this therapeutic approach. Previously we demonstrated that patients with leukemia who lack donor hematopoiesis in relapse after BMT experience severe and lasting aplasia after infusion of donor leukocytes. In two patients - one with extramedullary and one with marrow relapse after a sex-mismatched transplantation - we analyzed hematopoietic chimerism by cell sorting and bone marrow cultures. CD34-positive cells, CD4-CD8-positive cells, committed progenitors, and LTC-IC were of donor origin, as demonstrated by two-color fluorescence in situ hybridization (FISH). Additionally, in relapse complete donor T-cell chimerism was seen. In contrast, plasma cells were of recipient origin in the patient who had a relapse in the bone marrow. Both patients were treated with infusions of donor leukocytes from their original donor. Neither patient suffered myelosuppression, and one achieved a stable complete remission.
一大群异基因骨髓移植（BMT）后复发的患者在输注来自其原始供体的白细胞后获得了缓解，提示存在移植物抗骨髓瘤效应。然而，移植物抗宿主病和骨髓抑制等副作用是这种治疗方法严重且有时致命的并发症。此前我们证明，BMT后复发且缺乏供体造血的白血病患者在输注供体白细胞后会经历严重且持久的再生障碍。在两名患者中——一名是在性别不匹配移植后出现髓外复发，另一名是骨髓复发——我们通过细胞分选和骨髓培养分析了造血嵌合体。双色荧光原位杂交（FISH）显示，CD34阳性细胞、CD4 - CD8阳性细胞、定向祖细胞和长期培养起始细胞（LTC - IC）均来自供体。此外，在复发时可见完全的供体T细胞嵌合体。相比之下，骨髓复发患者的浆细胞来自受体。两名患者均接受了来自其原始供体的供体白细胞输注。两名患者均未出现骨髓抑制，其中一名实现了稳定的完全缓解。
