Soiffer R J, Ritz J
Dana-Farber Cancer Institute, Boston, MA 02115.
Bone Marrow Transplant. 1993;12 Suppl 3:S7-10.
Acute and chronic graft-versus-host disease (GVHD) are responsible for a significant fraction of the morbidity and mortality of allogeneic bone marrow transplantation. Attempts to reduce the incidence of GVHD by exhaustive T cell depletion of donor marrow have frequently been associated with an increase in graft failure and disease relapse. For the past 10 years, we have evaluated the use of a monoclonal antibody (T12) that selectively targets the CD6 determinant on mature T cells. 171 patients with hematologic malignancies have received donor marrow depleted of mature T cells with anti-CD6 and rabbit complement. Initial engraftment in recipients of HLA-matched marrow has been > 98% with 96% of patients showing stable hematologic reconstitution. The incidence of acute GVHD in this population was only 15%. Chronic GVHD has developed in 5% of patients. Overall, transplant-related mortality was 17%. Examination of peripheral blood lymphocyte reconstitution in the early post-BMT period has been helpful in predicting which patients will ultimately go on to develop GVHD. Treatment of recipients of CD6 depleted marrow with low doses of interleukin-2 post-BMT can expand the number of circulating NK cells and may be associated with a decrease in disease relapse rate.
急性和慢性移植物抗宿主病（GVHD）是异基因骨髓移植发病率和死亡率的重要组成部分。通过彻底清除供体骨髓中的T细胞来降低GVHD发病率的尝试，常常伴随着移植失败和疾病复发率的增加。在过去10年中，我们评估了一种单克隆抗体（T12）的应用，该抗体可选择性靶向成熟T细胞上的CD6决定簇。171例血液系统恶性肿瘤患者接受了用抗CD6和兔补体清除成熟T细胞的供体骨髓。HLA匹配骨髓受者的初始植入率>98%，96%的患者显示血液学重建稳定。该人群中急性GVHD的发生率仅为15%。5%的患者发生了慢性GVHD。总体而言，移植相关死亡率为17%。对骨髓移植后早期外周血淋巴细胞重建的检查有助于预测哪些患者最终会发生GVHD。骨髓移植后用低剂量白细胞介素-2治疗CD6清除骨髓的受者，可以增加循环NK细胞的数量，并且可能与疾病复发率的降低有关。
