Wang Yan, Lv Benji, Li Ke, Zhang Anqi, Liu Hong
Department of Clinical Laboratory.
Department of Blood Transfusion.
Drug Des Devel Ther. 2017 Nov 15;11:3245-3256. doi: 10.2147/DDDT.S146959. eCollection 2017.
The aim of this study was to systematically evaluate the efficacy and safety of the combination of dendritic cells and cytokine-induced killer cells (DC-CIK) adjuvant immunotherapy and chemotherapy in the treatment of multiple myeloma (MM).
Clinical trials were gathered by searching Web of Science, PubMed, Embase, Cochrane Library, Wanfang, and CNKI database. Outcome measurements including therapeutic efficacy, prognosis, immune function, and adverse events were extracted and evaluated.
A total of 12 trials including 594 MM patients were involved in this study for statistical analysis. Results indicated that compared to chemotherapy alone, the combination of DC-CIK immunotherapy with chemotherapy significantly improved patients' overall response rate (ORR, odds ratio [OR] =2.77, 95% confidence interval [CI] =1.88-4.10, <0.00001), disease control rate (DCR, OR =2.90, CI =1.72-4.90, <0.0001), and life quality (<0.00001). The combined therapy showed advantages over chemotherapy alone in prognostic indicators including percentage of tumor cells (=0.04), serum levels of β2-microglobin (<0.0001), M protein (<0.00001), and creatinine (<0.0001), and 24 h urine light chains (<0.00001). After combined treatment, CD4 lymphocyte subsets' percentages, CD4/CD8 ratio, and cytokines levels of AgNOR, IFN-γ, IL-2, and IL-12 were significantly increased (<0.05), whereas CD8 and CD4CD25 percentages and IL-4, IL-6, IL-10, and TGF-β levels were obviously decreased (<0.01), indicating a recovered immune condition.
Adjuvant DC-CIK immunotherapy enhances the efficacy of chemotherapy for MM and improves prognosis probably by reconstructing immune function.
本研究旨在系统评价树突状细胞与细胞因子诱导的杀伤细胞（DC-CIK）联合辅助免疫治疗与化疗在治疗多发性骨髓瘤（MM）中的疗效和安全性。
通过检索Web of Science、PubMed、Embase、Cochrane图书馆、万方和知网数据库收集临床试验。提取并评估包括治疗效果、预后、免疫功能和不良事件在内的结果指标。
本研究共纳入12项试验，涉及594例MM患者进行统计分析。结果表明，与单纯化疗相比，DC-CIK免疫治疗联合化疗显著提高了患者的总缓解率（ORR，优势比[OR]=2.77，95%置信区间[CI]=1.88-4.10，<0.00001）、疾病控制率（DCR，OR=2.90，CI=1.72-4.90，<0.0001）和生活质量（<0.00001）。联合治疗在预后指标方面显示出优于单纯化疗的优势，包括肿瘤细胞百分比（=0.04）、血清β2-微球蛋白水平（<0.0001）、M蛋白（<0.00001）、肌酐（<0.0001）和24小时尿轻链（<0.00001）。联合治疗后，CD4淋巴细胞亚群百分比、CD4/CD8比值以及AgNOR、IFN-γ、IL-2和IL-12的细胞因子水平显著升高（<0.05），而CD8和CD4CD25百分比以及IL-4、IL-6、IL-10和TGF-β水平明显降低（<0.01），表明免疫状态得到恢复。
辅助DC-CIK免疫治疗可增强化疗对MM的疗效，并可能通过重建免疫功能改善预后。
