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人类同种异体骨髓移植受者抗体产生的恢复:移植后时间、慢性移植物抗宿主病的有无以及抗胸腺细胞球蛋白治疗的影响。

Recovery of antibody production in human allogeneic marrow graft recipients: influence of time posttransplantation, the presence or absence of chronic graft-versus-host disease, and antithymocyte globulin treatment.

作者信息

Witherspoon R P, Storb R, Ochs H D, Fluornoy N, Kopecky K J, Sullivan K M, Deeg J H, Sosa R, Noel D R, Atkinson K, Thomas E D

出版信息

Blood. 1981 Aug;58(2):360-8.

PMID:6454452
Abstract

One-hundred fifty-three recipients of HLA-identical sibling marrow transplants for aplastic anemia or hematologic malignancy were injected with bacteriophage phi X174 (phage), pneumococcal polysaccharide antigen (PPA), or keyhole limpet hemocyanin (KLH). Antibody levels were determined several times in the 6 wk after injection. Multiple regression techniques were used to determine what factors played significant roles in the antibody response. The most significant factors were the time elapsed from transplantation, chronic graft-versus-host disease (GVHD), and antithymocyte globulin (ATG) treatment. All patients had low antibody responses to all antigens in the first 180 days from transplant. Beyond 180 days patients without chronic GVHD showed antibody responses indistinguishable from those of normal donors. However, patients with chronic GVHD had the following impairments: (1) primary response to phage, (2) conversion from IgM to IgG in secondary response to phage, (3) secondary response to KLH, and (4) response to PPA. ATG treatment given to patients either prophylactically or therapeutically for acute GVHD was followed by lower primary responses to phage in the first 180 days and poor ability to switch from IgM to IgG antibody in the secondary response beyond 180 days postgrafting. Other factors did not yield additional significant information about ability to predict antibody responses including diagnosis, conditioning regimen, treatment in or out of laminar air flow rooms, transplantation, pretransplant refractoriness of the recipient to platelet transfusions from random donors, donor age or donor sex, and steroid administration for treatment for prevention of GVHD. The data indicate that, given enough time after transplantation, the ability to produce normal antibody function recovers except in those patients experiencing chronic GVHD.

摘要

153例接受同基因 HLA 同胞骨髓移植治疗再生障碍性贫血或血液系统恶性肿瘤的患者,分别注射了噬菌体 phi X174(噬菌体)、肺炎球菌多糖抗原(PPA)或钥孔戚血蓝蛋白(KLH)。在注射后的6周内多次测定抗体水平。采用多元回归技术确定哪些因素在抗体反应中起重要作用。最重要的因素是移植后的时间、慢性移植物抗宿主病(GVHD)和抗胸腺细胞球蛋白(ATG)治疗。所有患者在移植后的前180天对所有抗原的抗体反应均较低。180天后,没有慢性GVHD的患者的抗体反应与正常供体无异。然而,患有慢性GVHD的患者有以下功能受损:(1)对噬菌体的初次反应;(2)对噬菌体二次反应中从IgM向IgG的转换;(3)对KLH的二次反应;(4)对PPA的反应。为预防或治疗急性GVHD而给予患者ATG治疗后,在移植后的前180天对噬菌体的初次反应较低,且在移植后180天以上的二次反应中从IgM转换为IgG抗体的能力较差。其他因素在预测抗体反应能力方面没有提供更多重要信息,包括诊断、预处理方案、在层流室内外的治疗、移植、移植前受体对随机供体血小板输注的难治性、供体年龄或供体性别以及用于预防GVHD的类固醇给药。数据表明,移植后给予足够的时间,除了那些患有慢性GVHD的患者外,产生正常抗体功能的能力会恢复。

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