Department of Hematology and Medical Oncology, Winship Cancer Institute, Atlanta, Georgia 30322, USA.
Transfusion. 2010 Nov;50(11):2424-31. doi: 10.1111/j.1537-2995.2010.02712.x.
One proposed mechanism of extracorporeal photopheresis (ECP) in reducing chronic graft-versus-host disease (cGVHD) is alteration in numbers of circulating dendritic cells (DCs). This hypothesis was tested by correlating numbers of DC precursors and T cells in the blood before and during ECP therapy with response of cGVHD.
Twenty-five patients with cGVHD were treated with ECP. Data were collected with emphasis on blood cellular markers, clinical response to ECP, and overall survival.
Fourteen patients (56%) responded and had better 2-year survival than nonresponders (88% vs. 18%, p=0.003). Responders had higher baseline circulating myeloid DC (mDC) and plasmacytoid DC precursors and CD4+ and CD8+ T cells compared with nonresponders. Receiver operating characteristic curve analyses showed that the best baseline cutoff values to predict response to ECP were mDC counts of 3.7 cells/µL (79% sensitivity, 82% specificity) and CD4+ T-cell counts of 104 cells/µL (71% sensitivity, 82% specificity). CD4+ T cells declined in responders over time, but not in nonresponders, and no significant changes were seen in CD8 T-cell or DC numbers over a 12-month period in responder or nonresponder groups.
Higher baseline numbers of circulating DCs and T cells may predict clinical response to ECP in patients with cGVHD.
体外光分离（ECP）减少慢性移植物抗宿主病（cGVHD）的一种机制是改变循环树突状细胞（DC）的数量。本研究通过检测 EC 治疗前和治疗期间血液中 DC 前体和 T 细胞的数量与 cGVHD 反应的相关性来验证该假说。
25 例 cGVHD 患者接受 ECP 治疗。重点收集血液细胞标志物、对 ECP 的临床反应和总生存率数据。
14 例患者（56%）有反应，2 年生存率优于无反应者（88%对 18%，p=0.003）。与无反应者相比，有反应者的基线循环髓样 DC（mDC）和浆细胞样 DC 前体以及 CD4+和 CD8+T 细胞更高。受试者工作特征曲线分析显示，预测 ECP 反应的最佳基线截止值为 mDC 计数 3.7 细胞/µL（79%敏感性，82%特异性）和 CD4+T 细胞计数 104 细胞/µL（71%敏感性，82%特异性）。有反应者的 CD4+T 细胞随时间下降，但无反应者没有，在 12 个月的时间内，有反应者和无反应者组的 CD8 T 细胞或 DC 数量均无显著变化。
基线时循环 DC 和 T 细胞数量较高可能预测 cGVHD 患者对 ECP 的临床反应。
