Gale R P, Horowitz M M
Department of Medicine, UCLA School of Medicine 90024-1678.
Bone Marrow Transplant. 1990 Jul;6 Suppl 1:94-7.
We studied 2254 persons receiving HLA-identical sibling bone marrow transplants for acute myelogenous leukemia (AML) or acute lymphoblastic leukemia (ALL) in first remission, or chronic myelogenous leukemia (CML) in first chronic phase to determine whether graft-versus-leukemia (GvL) reactions are important in preventing leukemia recurrence after bone marrow transplantation. Four groups were investigated; recipients of non-T-cell depleted allografts without graft-versus-host disease (GvHD), recipients of non-T-cell depleted allografts with GvHD, recipients of T-cell depleted allografts, and recipients of genetically identical twin transplants compared with recipients of non-T-cell depleted allografts without GvHD, Decreased relapse was observed in recipients of non-T-cell depleted allografts with acute (relative risk 0.68, P = 0.03), chronic (relative risk, 0.43, P = 0.01), and both acute and chronic GvHD (relative risk 0.33, P = 0.0001). These data support an anti-leukemia effect of GvHD. AML patients receiving identical twin transplants had an increased probability of relapse (relative risk 2.58, P = 0.008) compared to allograft recipients without GvHD supporting an anti-leukemia effect of allografts independent of GvHD. CML patients receiving T-cell depleted transplants without GvHD had a higher probability of relapse (relative risk 6.91, P = 0.0001) than recipients of non-T-cell depleted allografts without GvHD. These data support an antileukemia effect independent of GvHD altered by T-cell depletion. These results indicate that much of the anti-leukemia effect of bone marrow transplants is related to immune factors rather than high-dose chemotherapy and/or radiation.
我们研究了2254名接受 HLA 相同同胞骨髓移植的患者，这些患者分别处于急性髓细胞白血病（AML）或急性淋巴细胞白血病（ALL）的首次缓解期，或慢性髓细胞白血病（CML）的首次慢性期，以确定移植物抗白血病（GvL）反应在预防骨髓移植后白血病复发中是否重要。研究了四组患者；未发生移植物抗宿主病（GvHD）的非 T 细胞去除同种异体移植受者、发生 GvHD 的非 T 细胞去除同种异体移植受者、T 细胞去除同种异体移植受者，以及与未发生 GvHD 的非 T 细胞去除同种异体移植受者相比的同基因双胞胎移植受者。在发生急性（相对风险0.68，P = 0.03）、慢性（相对风险0.43，P = 0.01）以及急性和慢性 GvHD 均有的（相对风险0.33，P = 0.0001）非 T 细胞去除同种异体移植受者中观察到复发率降低。这些数据支持 GvHD 的抗白血病作用。与未发生 GvHD 的同种异体移植受者相比，接受同基因双胞胎移植的 AML 患者复发概率增加（相对风险2.58，P = 0.008），这支持了同种异体移植独立于 GvHD 的抗白血病作用。接受无 GvHD 的 T 细胞去除移植的 CML 患者比接受无 GvHD 的非 T 细胞去除同种异体移植的患者复发概率更高（相对风险6.91，P = 0.0001）。这些数据支持了 T 细胞去除改变的独立于 GvHD 的抗白血病作用。这些结果表明，骨髓移植的抗白血病作用很大程度上与免疫因素有关，而非大剂量化疗和/或放疗。
