Flinn Aisling M, Gennery Andrew R
Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK.
Primary Immunodeficiency Group, Institute of Cellular Medicine, Newcastle University, Newcastle upon Tyne, UK; Paediatric Haematopoietic Stem Cell Unit, Great North Children's Hospital, Newcastle upon Tyne, UK.
F1000Res. 2016 Jun 27;5. doi: 10.12688/f1000research.8118.1. eCollection 2016.
Acute graft-versus-host disease (aGvHD) continues to be a major obstacle to allogeneic haematopoietic stem cell transplantation. Thymic damage secondary to aGvHD along with corticosteroids and other non-selective T lymphocyte-suppressive agents used in the treatment of aGvHD concurrently impair thymopoiesis and negatively impact on immunoreconstitution of the adaptive immune compartment and ultimately adversely affect clinical outcome. Extracorporeal photopheresis (ECP) is an alternative therapeutic strategy that appears to act in an immunomodulatory fashion, potentially involving regulatory T lymphocytes and dendritic cells. By promoting immune tolerance and simultaneously avoiding systemic immunosuppression, ECP could reduce aGvHD and enable a reduction in other immunosuppression, allowing thymic recovery, restoration of normal T lymphopoiesis, and complete immunoreconstitution with improved clinical outcome. Although the safety and efficacy of ECP has been demonstrated, further randomised controlled studies are needed as well as elucidation of the underlying mechanisms responsible and the effect of ECP on thymic recovery.
急性移植物抗宿主病（aGvHD）仍然是异基因造血干细胞移植的主要障碍。aGvHD继发的胸腺损伤，以及用于治疗aGvHD的皮质类固醇和其他非选择性T淋巴细胞抑制药物，同时损害胸腺生成，并对适应性免疫区室的免疫重建产生负面影响，最终对临床结果产生不利影响。体外光化学疗法（ECP）是一种替代治疗策略，似乎以免疫调节方式起作用，可能涉及调节性T淋巴细胞和树突状细胞。通过促进免疫耐受并同时避免全身免疫抑制，ECP可以减少aGvHD，并减少其他免疫抑制，使胸腺恢复、正常T淋巴细胞生成恢复，并实现完全免疫重建，改善临床结果。尽管ECP的安全性和有效性已得到证实，但仍需要进一步的随机对照研究，以及对其潜在机制和ECP对胸腺恢复的影响进行阐明。
