Margolis J, Borrello I, Flinn I W
Johns Hopkins Oncology Center, Baltimore, MD 21231, USA.
Semin Oncol. 2000 Oct;27(5):524-30.
Stem cell transplantation has been successfully used to treat a wide variety of hematologic malignancies. New and exciting strategies being developed for use in conjunction with transplant will be useful in overcoming tumor resistance. It is now clear that a significant part of the antitumor effect of allogeneic stem cell transplantation is derived from the graft itself and is independent of the preparative regimen. Immune therapy derived from the donor's graft is uniquely suited for killing chemoresistant tumor cells and may prove to be an invaluable tool for decreasing the risk of relapse in patients with advanced disease. Among patients who have relapsed after allogeneic bone marrow transplantation (BMT), an immunologically based antitumor effect may be obtained simply by transfusing T cells obtained by leukopheresis of the original bone marrow donor. Referred to as donor leukocyte infusion (DLI), this technique has been used to obtain complete remissions in relapsed acute myeloid leukemia (AML), acute lymphocytic leukemia (ALL), multiple myeloma, non-Hodgkin's lymphoma, myelodysplastic syndrome (MDS), and chronic myeloid leukemia (CML). Another approach that uses the donor's graft to obtain a potent antitumor effect is the combination of nonmyeloablative BMT followed by immunotherapy with DLI. Numerous investigators are exploring ways of combining autologous BMT with immune therapy. Animal studies using tumor vaccines in conjunction with autologous transplantation offer a promising method for eliminating tumor. Patients undergoing autologous transplantation may have marrow that has been contaminated with tumor, which places them at a higher risk of relapse. Attempts have been made to eliminate contaminating tumor from the marrow by purging.
干细胞移植已成功用于治疗多种血液系统恶性肿瘤。正在研发的与移植联合使用的新的、令人兴奋的策略将有助于克服肿瘤耐药性。现在很清楚，异基因干细胞移植的抗肿瘤作用很大一部分源自移植物本身，且独立于预处理方案。源自供体移植物的免疫疗法特别适合杀死化疗耐药的肿瘤细胞，可能被证明是降低晚期疾病患者复发风险的宝贵工具。在异基因骨髓移植（BMT）后复发的患者中，简单地输注通过白细胞分离术从原骨髓供体获得的T细胞，可能获得基于免疫的抗肿瘤作用。这种技术被称为供体白细胞输注（DLI），已用于使复发的急性髓系白血病（AML）、急性淋巴细胞白血病（ALL）、多发性骨髓瘤、非霍奇金淋巴瘤、骨髓增生异常综合征（MDS）和慢性髓系白血病（CML）获得完全缓解。另一种利用供体移植物获得强大抗肿瘤作用的方法是将非清髓性BMT与DLI免疫疗法相结合。许多研究人员正在探索将自体BMT与免疫疗法相结合的方法。使用肿瘤疫苗联合自体移植的动物研究提供了一种有前景的消除肿瘤的方法。接受自体移植的患者的骨髓可能已被肿瘤污染，这使他们有更高的复发风险。人们已尝试通过净化来消除骨髓中污染的肿瘤。
