Parkman Robertson, Cohen Geoff, Carter Shelly L, Weinberg Kenneth I, Masinsin Bernadette, Guinan Eva, Kurtzberg Joanne, Wagner John E, Kernan Nancy A
Division of Research Immunology/Bone Marrow Transplantation, Childrens Hospital Los Angeles, The Saban Research Institute, 4650 Sunset Boulevard, Mail Stop 62, Los Angeles, CA 90027, USA.
Biol Blood Marrow Transplant. 2006 Sep;12(9):919-27. doi: 10.1016/j.bbmt.2006.05.008.
Allogeneic hematopoietic stem cell transplantation (HSCT) is established therapy for selected patients with acute leukemia. After transplantation, antileukemic immune responses are believed to eliminate residual leukemia cells and decrease the likelihood of relapse. However, the clinical effect of successful antigen-specific immune reconstitution after HSCT on the likelihood of leukemic relapse and overall survival is not known. Pediatric recipients of unrelated cord blood transplants who underwent transplantation for acute leukemia were sequentially evaluated for their development of antigen-specific T-lymphocyte immunity to herpes viruses. The clinical effect of a positive antigen-specific response on relapse-free survival was determined. The presence of an antigen-specific response resulted in a relapse-free survival advantage (P = .0001), which was primarily due to a decrease in leukemic relapse (P = .003). Proportional hazards modeling for time to relapse and time to relapse or death defined 3 variables that were strongly associated with a poor outcome: female gender, poor remission status before transplantation, and negative antigen-specific T-lymphocyte proliferation. Notably neither acute nor chronic graft-versus-host disease had any effect on the incidence of leukemic relapse. Successful antigen-specific immune reconstitution after unrelated cord blood transplantation results in decreased leukemic relapse and improved overall survival.
异基因造血干细胞移植（HSCT）是针对特定急性白血病患者的既定疗法。移植后，抗白血病免疫反应被认为可消除残留的白血病细胞并降低复发可能性。然而，HSCT后成功进行抗原特异性免疫重建对白血病复发可能性和总生存期的临床效果尚不清楚。对因急性白血病接受无关脐血移植的儿科受者，依次评估其对疱疹病毒的抗原特异性T淋巴细胞免疫的发展情况。确定了抗原特异性反应阳性对无复发生存的临床效果。抗原特异性反应的存在带来了无复发生存优势（P = .0001），这主要归因于白血病复发的减少（P = .003）。对复发时间和复发或死亡时间的比例风险建模确定了3个与不良结局密切相关的变量：女性性别、移植前缓解状态不佳以及抗原特异性T淋巴细胞增殖阴性。值得注意的是，急性和慢性移植物抗宿主病均对白血病复发率没有任何影响。无关脐血移植后成功进行抗原特异性免疫重建可降低白血病复发率并改善总生存期。
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