Collins R H, Rogers Z R, Bennett M, Kumar V, Nikein A, Fay J W
Bone Marrow Transplantation Research, Charles A. Sammons Cancer Center, Baylor University Medical Center, Dallas, TX 75246.
Bone Marrow Transplant. 1992 Oct;10(4):391-5.
Two patients with hematologic relapse of chronic myelogenous leukemia (CML) following allogeneic BMT were treated by abrupt discontinuation of cyclosporine. Both patients rapidly attained complete hematologic and cytogenetic remission and remain free of disease with long follow-up. In the first patient, disappearance of CML was associated with the development of graft-versus-host disease (GVHD). In the second patient GVHD did not develop until after clearing of disease had been documented by cytogenetic analysis. Laboratory studies in the second patient disclosed the presence of lytic activity against both K562 and autologous CML cells that enhanced with IL2. Correlation with serial immunophenotyping data from this patient suggests that the effector for this graft-versus-leukemia (GVL) reaction could have been a T lymphocyte. Abrupt discontinuation of post-transplant immunosuppression with cyclosporine may represent a therapeutic approach to CML which has recurred following BMT. Moreover, investigation of this clinical phenomenon in subsequent cases may permit direct study of the cellular mechanisms involved in the GVL effect.
两名异基因骨髓移植（BMT）后慢性粒细胞白血病（CML）血液学复发的患者通过突然停用环孢素进行治疗。两名患者均迅速实现了完全血液学和细胞遗传学缓解，且经过长期随访仍无疾病复发。在首例患者中，CML的消失与移植物抗宿主病（GVHD）的发生有关。在第二例患者中，直到通过细胞遗传学分析记录到疾病清除后GVHD才出现。对第二例患者的实验室研究发现，其存在针对K562细胞和自体CML细胞的裂解活性，且这种活性在白细胞介素2（IL2）作用下增强。与该患者系列免疫表型分析数据的相关性表明，这种移植物抗白血病（GVL）反应的效应细胞可能是T淋巴细胞。突然停用移植后用于免疫抑制的环孢素可能是BMT后复发的CML的一种治疗方法。此外，对后续病例中这一临床现象的研究可能有助于直接研究GVL效应所涉及的细胞机制。
