Barrett A John
Hematology Branch, National Heart, Lung and Blood Institute, National Institutes of Health, Bethesda, MD 20892-1220, USA.
Br J Haematol. 2008 Sep;142(6):877-88. doi: 10.1111/j.1365-2141.2008.07260.x. Epub 2008 Jun 28.
The graft-versus-leukaemia (GVL) effect is a central component of the stem cell allograft's ability to cure haematological malignancies. The GVL effect is mediated by donor-derived natural killer cells and T lymphocytes, which have distinct mechanisms of recognizing and targeting the recipient's malignant cells. After transplantation the cytokine milieu is favourable to the early establishment of a GVL effect, but the need to prevent graft-versus-host disease limits the full potential of this process. Clinical studies have identified some critical components of the transplant preparation, donor selection, stem cell source (peripheral blood versus bone marrow) and post-transplant management that can be manipulated to optimize the GVL effect. However, further developments focusing on the selective depletion of unwanted alloreactivity with preservation of GVL effects, and the use of vaccines or the adoptive transfer of leukaemia-specific lymphocytes, will be required to enhance the GVL effect to reliably eradicate more resistant leukaemias.
移植物抗白血病（GVL）效应是干细胞同种异体移植治愈血液系统恶性肿瘤能力的核心组成部分。GVL效应由供体来源的自然杀伤细胞和T淋巴细胞介导，它们识别和靶向受体恶性细胞的机制各不相同。移植后，细胞因子环境有利于GVL效应的早期建立，但预防移植物抗宿主病的需要限制了这一过程的全部潜力。临床研究已经确定了移植准备、供体选择、干细胞来源（外周血与骨髓）和移植后管理的一些关键组成部分，这些部分可以进行调整以优化GVL效应。然而，需要进一步开展研究，重点是在保留GVL效应的同时选择性消除不必要的同种异体反应性，以及使用疫苗或过继转移白血病特异性淋巴细胞，以增强GVL效应，从而可靠地根除更具抗性的白血病。
