National Clinical Research Center for Hematologic Disease, Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation, Peking University People's Hospital, Peking University Institute of Hematology, Beijing, China.
Peking-Tsinghua Center for Life Sciences, Academy for Advanced Interdisciplinary Studies, Peking University, Beijing, China.
Expert Rev Clin Immunol. 2024 May;20(5):513-524. doi: 10.1080/1744666X.2023.2299728. Epub 2024 Jan 10.
Leukemia relapse following stem cell transplantation remains a significant barrier to long-term remission. Timely and balanced immune recovery after transplantation is crucial for preventing leukemia relapse.
After an extensive literature search of PubMed and Web of Science through October 2023, we provide an overview of the dynamics of immune reconstitution and its role in controlling leukemia relapse. We also discuss strategies to promote immune reconstitution and reduce disease recurrence following allogeneic hematopoietic stem cell transplantation.
Immune reconstitution after transplantation has substantial potential to prevent relapse and might predict disease recurrence and prognosis. High dimensional cytometry, multi-omics, and T cell repertoire analysis allow for a more comprehensive and detailed understanding of the immune system's dynamics post-transplantation, and contribute to the identification of rare immune cell subsets or potential biomarkers associated with successful immune reconstitution or increased risk of complications. Strategies to enhance the immune system, such as adoptive immunotherapy and cytokine-based therapy, have great potential for reducing leukemia relapse after transplantation. Future research directions should focus on refining patient selection for these therapies, implementing appropriate and timely treatment, investigating combination approaches to maximize therapeutic outcomes, and achieving a robust graft-versus-leukemia (GVL) effect while minimizing graft-versus-host disease (GVHD) for optimal results.
干细胞移植后白血病复发仍是长期缓解的重大障碍。移植后及时和平衡的免疫恢复对于预防白血病复发至关重要。
通过对 2023 年 10 月之前的 PubMed 和 Web of Science 进行广泛的文献检索，我们提供了免疫重建动力学及其在控制白血病复发中的作用概述。我们还讨论了促进异基因造血干细胞移植后免疫重建和降低疾病复发的策略。
移植后免疫重建具有很大的潜力来预防复发，并可能预测疾病复发和预后。高维流式细胞术、多组学和 T 细胞受体库分析可更全面、更详细地了解移植后免疫系统的动态，并有助于识别与成功免疫重建或增加并发症风险相关的罕见免疫细胞亚群或潜在生物标志物。增强免疫系统的策略，如过继免疫疗法和细胞因子治疗，具有降低移植后白血病复发的巨大潜力。未来的研究方向应侧重于完善这些疗法的患者选择，实施适当和及时的治疗，研究联合治疗方法以最大限度地提高治疗效果，并在获得最佳结果的同时实现强大的移植物抗白血病（GVL）效应，同时最小化移植物抗宿主病（GVHD）。
