供体白细胞输注后的移植物抗宿主病：表现与管理
Graft-versus-host disease after donor leukocyte infusions: presentation and management.
作者信息
Frey Noelle V, Porter David L
机构信息
Division of Hematology-Oncology and Abramson Cancer Center, University of Pennsylvania Medical Center, 16 Penn Tower, 3400 ISpruce St, Philadelphia PA 19106, USA.
出版信息
Best Pract Res Clin Haematol. 2008 Jun;21(2):205-22. doi: 10.1016/j.beha.2008.02.007.
Abstract
Donor leukocyte infusion (DLI) is used after both myeloablative and non-myeloablative stem-cell transplantation to treat and prevent relapse, to establish full donor chimerism, and to treat and prevent infections. The major treatment-related complication of DLI is graft-versus-host disease (GVHD). The presentation and treatment of GVHD after DLI is similar to its presentation and treatment after stem-cell transplantation, with some notable exceptions. While GVHD and graft-versus-tumor (GVT) effects are highly correlated after DLI, some patients experience remission without GVHD. Studies to define tumor-specific target antigens and GVT effector cells, as well as strategies of donor T-cell manipulation and optimization of DLI dose and schedule, may ultimately lead to the consistent ability to separate GVHD from GVT activity, improvement in the safety and specificity of DLI, and enhancement of the anti-tumor activity of donor T cells.
摘要
供体白细胞输注（DLI）用于清髓性和非清髓性干细胞移植后，以治疗和预防复发、建立完全供体嵌合状态以及治疗和预防感染。DLI的主要治疗相关并发症是移植物抗宿主病（GVHD）。DLI后GVHD的表现和治疗与干细胞移植后的表现和治疗相似，但有一些显著例外。虽然DLI后GVHD和移植物抗肿瘤（GVT）效应高度相关，但一些患者在无GVHD的情况下实现缓解。确定肿瘤特异性靶抗原和GVT效应细胞的研究，以及供体T细胞操作策略和DLI剂量与方案的优化，最终可能导致始终能够将GVHD与GVT活性分离，提高DLI的安全性和特异性，并增强供体T细胞的抗肿瘤活性。
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