Marmont A M
II Division of Hematology, S. Martino's Hospital, Genova, Italy.
Leuk Lymphoma. 1993;11 Suppl 1:221-6. doi: 10.3109/10428199309047890.
Immune mechanisms superimposed to the myeloablative conditioning regimens exert an additional powerful effect in eradicating leukemia and in achieving immunological control of minimal residual disease. The impact of GVHD-independent GVL has been evaluated to be absent, or near absent, in ALL, about 30% in AML and about 40% in CML. While until little time ago most of the evidence in favor of an immune antileukemia mechanism exerted by allo BMT in CML was indirect, based on the lack of GVL, there is now solid evidence of a positive type, based on the antileukemia effect of donor lymphocyte infusions in patients having relapsed after transplant. There are three lines of indirect clinical evidence for GVL in CML: they include the classical linkage between GVHD and reduced relapse rate, increased relapse rate after identical twin allografts, and increased relapse risk after effective GVHD prophylaxis, with T lymphocyte depletion in the foreground. The eradicating effects of donor lymphocyte infusions in relapsed patients are the ultimate demonstration that allogeneic immune competent cells are capable of recognizing and destroying the Ph-positive clone. However the frequency of irreversible aplasia indicates that donor lymphocytes act in the same way on residual host hematopoiesis, so that a second graft, without repeat conditioning, should be programmed for such cases.
叠加于清髓性预处理方案之上的免疫机制在根除白血病及实现对微小残留病的免疫控制方面发挥着额外的强大作用。在急性淋巴细胞白血病（ALL）中，不依赖移植物抗宿主病（GVHD）的移植物抗白血病（GVL）作用被评估为不存在或几乎不存在，在急性髓细胞白血病（AML）中约为30%，在慢性髓细胞白血病（CML）中约为40%。虽然直到不久前，支持异基因骨髓移植（allo BMT）在CML中发挥免疫抗白血病机制的大多数证据都是间接的，基于缺乏GVL，但现在有确凿的阳性证据，这基于供体淋巴细胞输注对移植后复发患者的抗白血病作用。在CML中存在三条支持GVL的间接临床证据：它们包括GVHD与复发率降低之间的经典关联、同卵双胞胎同种异体移植后复发率增加以及有效的GVHD预防（以T淋巴细胞耗竭为主）后复发风险增加。供体淋巴细胞输注对复发患者的根除作用最终证明了同种异体免疫活性细胞能够识别并破坏费城染色体阳性克隆。然而，不可逆再生障碍的发生率表明供体淋巴细胞对残留的宿主造血作用方式相同，因此对于此类病例应计划进行第二次移植，而无需重复预处理。
