移植物抗白血病效应:供者淋巴细胞输注和细胞治疗。

The graft versus leukemia effect: donor lymphocyte infusions and cellular therapy.

机构信息

Division of Hematologic Malignancies, Department of Medical Oncology, Dana-Farber Cancer Institute, Harvard Medical School, Boston, MA, United States.

出版信息

Front Immunol. 2024 Mar 15;15:1328858. doi: 10.3389/fimmu.2024.1328858. eCollection 2024.

Abstract

Allogeneic hematopoietic stem cell transplantation (HSCT) is a potentially curative therapy for many hematologic malignancies as well as non-malignant conditions. Part of the curative basis underlying HSCT for hematologic malignancies relies upon induction of the graft versus leukemia (GVL) effect in which donor immune cells recognize and eliminate residual malignant cells within the recipient, thereby maintaining remission. GVL is a clinically evident phenomenon; however, specific cell types responsible for inducing this effect and molecular mechanisms involved remain largely undefined. One of the best examples of GVL is observed after donor lymphocyte infusions (DLI), an established therapy for relapsed disease or incipient/anticipated relapse. DLI involves infusion of peripheral blood lymphocytes from the original HSCT donor into the recipient. Sustained remission can be observed in 20-80% of patients treated with DLI depending upon the underlying disease and the intrinsic burden of targeted cells. In this review, we will discuss current knowledge about mechanisms of GVL after DLI, experimental strategies for augmenting GVL by manipulation of DLI (e.g. neoantigen vaccination, specific cell type selection/depletion) and research outlook for improving DLI and cellular immunotherapies for hematologic malignancies through better molecular definition of the GVL effect.

摘要

异基因造血干细胞移植(HSCT)是许多血液系统恶性肿瘤和非恶性疾病的潜在根治性治疗方法。HSCT 治疗血液系统恶性肿瘤的部分根治基础在于诱导移植物抗白血病(GVL)效应,其中供体免疫细胞识别并消除受体内的残留恶性细胞,从而维持缓解。GVL 是一种临床明显的现象;然而,诱导这种效应的特定细胞类型和涉及的分子机制在很大程度上仍未确定。在供者淋巴细胞输注(DLI)后观察到最好的 GVL 之一的例子,DLI 是一种用于复发疾病或预期复发的既定治疗方法。DLI 涉及输注来自原始 HSCT 供体的外周血淋巴细胞到受体内。根据基础疾病和靶向细胞的固有负担,DLI 治疗的 20-80%的患者可观察到持续缓解。在这篇综述中,我们将讨论关于 DLI 后 GVL 的机制的现有知识,通过操纵 DLI 增强 GVL 的实验策略(例如,新抗原疫苗接种、特定细胞类型的选择/耗竭)以及通过更好地定义 GVL 效应来改善 DLI 和血液系统恶性肿瘤的细胞免疫疗法的研究展望。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/538b/10978651/19d44aa18659/fimmu-15-1328858-g001.jpg

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