Gratwohl A, Tichelli A, Würsch A, Dieterle A, Lori A, Thomssen C, Baldomero H, de Witte T, Nissen C, Speck B
Department of Internal Medicine, Kantonsspital Basel, Switzerland.
Bone Marrow Transplant. 1988 Nov;3(6):577-82.
Twenty patients aged 27-47 years (median, 35 years) with hematological malignancies, treated with T cell-depleted bone marrow transplantation received in a pilot study five donations of 15 Gy irradiated donor buffy coat cells at days +1, +3, +5, +7, +14 in order to prevent rejection and leukemic relapse. Patients were conditioned with etoposide, cyclophosphamide and 12 Gy fractionated total body irradiation and given cyclosporine postgrafting. Donor bone marrow was T cell-depleted (median 3% remaining T cells) by counterflow elutriation. All patients engrafted. Fourteen (70%) are alive. Two are living with relapse, 12 (60%) are alive and well without any signs of disease, 2-27 months (median, 9 months) post-transplant. Three patients died of interstitial pneumonitis and/or graft-versus-host-disease; three died of relapse. This pilot study supports previous animal data. Repeated infusions of 15 Gy irradiated donor buffy coat are feasible and do not appear to increase transplant related mortality. Whether this approach ultimately will reduce the rate of rejection and relapse following T cell depletion needs to be confirmed in a larger, prospective study.
在一项初步研究中，20名年龄在27 - 47岁（中位年龄35岁）的血液系统恶性肿瘤患者接受了去除T细胞的骨髓移植，并在第+1、+3、+5、+7、+14天接受了5次15 Gy照射的供体 Buffy 层细胞输注，以预防排斥反应和白血病复发。患者接受依托泊苷、环磷酰胺预处理及12 Gy分次全身照射，并在移植后给予环孢素。供体骨髓通过逆流淘析去除T细胞（剩余T细胞中位数为3%）。所有患者均实现造血重建。14名（70%）患者存活。2名患者复发后仍存活，12名（60%）患者存活且状况良好，无任何疾病迹象，移植后2 - 27个月（中位时间9个月）。3名患者死于间质性肺炎和/或移植物抗宿主病；3名患者死于复发。这项初步研究支持了先前的动物实验数据。重复输注15 Gy照射的供体Buffy层是可行的，且似乎不会增加移植相关死亡率。这种方法最终是否会降低去除T细胞后排斥反应和复发的发生率，需要在更大规模的前瞻性研究中得到证实。
