Kessinger A
University of Nebraska Medical Center, Omaha 68198-3300, USA.
Stem Cells. 1995 Jul;13(4):351-4. doi: 10.1002/stem.5530130405.
Bone marrow damage caused by myeloablative radiation therapy and/or chemotherapy can be repaired by intravenously infusing viable stem/progenitor cells collected from either blood or bone marrow. The hematopoietic graft product contains both stem/progenitor cells and populations of hematopoietic and nonhematopoietic (accessory) cells. The frequency of accessory cell types varies with the source of the graft product; marrow or blood. Reinfusion of these accessory cells causes effects other than the hematopoietic restoration provided by the stem/progenitor cells such as graft versus host disease and graft versus leukemia effect after allogeneic transplants. Effects of infused accessory cells in the autologous setting are less well studied and could provide ancillary advantages and/or disadvantages to the patient. Do these additional effects actually occur, and, if they do, are they more likely to appear following peripheral blood cell transplants (PBCT) or after autologous bone marrow transplants (AMBT)? Preliminary data are beginning to accumulate which suggest that reinfusion of occult tumor cells is less likely with PBCT, that immune reconstitution is different depending on the source of the autograft and that, for certain diseases, patient event-free survival following PBCT rather than ABMT may be better. However, infusion of occult tumor cells may result in re-establishment of the malignancy. If the accessory cells (including potential occult tumor cells) are eliminated from the product before transplant, will the patient have a better clinical outcome, or would benefits provided by infused accessory cells outweigh the risks of infused occult tumor cells? These controversial issues are in the very early stages of investigation.
清髓性放疗和/或化疗所导致的骨髓损伤，可通过静脉输注从血液或骨髓中采集的存活干细胞/祖细胞来修复。造血移植产物既包含干细胞/祖细胞，也包含造血细胞群和非造血（辅助）细胞群。辅助细胞类型的频率因移植产物的来源而异，即骨髓或血液。重新输注这些辅助细胞会产生除干细胞/祖细胞所提供的造血恢复之外的其他效应，例如同种异体移植后的移植物抗宿主病和移植物抗白血病效应。在自体移植情况下，输注辅助细胞的效应研究较少，可能给患者带来辅助性的益处和/或弊端。这些额外的效应实际会发生吗？如果会，它们更有可能出现在外周血细胞移植（PBCT）后还是自体骨髓移植（AMBT）后呢？初步数据开始积累，表明PBCT不太可能重新输注隐匿性肿瘤细胞，免疫重建因自体移植物来源而异，并且对于某些疾病，PBCT后而非ABMT后的患者无事件生存期可能更好。然而，输注隐匿性肿瘤细胞可能导致恶性肿瘤的重新形成。如果在移植前从产物中去除辅助细胞（包括潜在的隐匿性肿瘤细胞），患者的临床结局会更好吗？或者输注辅助细胞所带来的益处会超过输注隐匿性肿瘤细胞的风险吗？这些有争议的问题尚处于研究的早期阶段。
