Champlin R, Giralt S, Gajewski J
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Acta Haematol. 1996;95(3-4):157-63. doi: 10.1159/000203871.
Allogeneic bone marrow transplantation is most commonly used as treatment for leukemia. Allotransplantation is associated with several interrelated immunologic processes, graft rejection, graft-versus-host disease (GvHD) and graft versus leukemia (GvL). Graft rejection can be overcome by intensive pretransplant immunosuppressive therapy. Following transplantation, immunoreconstitution must occur from donor-derived progenitors and GvHD may occur from reactivity of donor-derived immunocompetent cells against host tissues. In a related, but distinct process, donor immunocompetent cells may react against the recipient leukemia and recent data confirm that this GvL effect plays a critical role in preventing posttransplant relapse. This report summarizes present data regarding the mechanism of these processes. A major challenge is to separate the beneficial GvL effect from GvHD, the major complication of allogeneic marrow transplantation. We summarize data regarding innovative approaches to modify the composition of the transplanted marrow to optimize clinical outcome as well as use of donor lymphocyte infusions as a means to induce posttransplant GvL.
异基因骨髓移植最常用于治疗白血病。同种异体移植与几个相互关联的免疫过程、移植物排斥、移植物抗宿主病（GvHD）和移植物抗白血病（GvL）相关。通过强化移植前免疫抑制治疗可以克服移植物排斥。移植后，免疫重建必须由供体来源的祖细胞发生，并且GvHD可能由供体来源的免疫活性细胞对宿主组织的反应性引起。在一个相关但不同的过程中，供体免疫活性细胞可能对受体白血病产生反应，最近的数据证实这种GvL效应在预防移植后复发中起关键作用。本报告总结了关于这些过程机制的现有数据。一个主要挑战是将有益的GvL效应与GvHD区分开来，GvHD是异基因骨髓移植的主要并发症。我们总结了关于创新方法的数据，这些方法可改变移植骨髓的组成以优化临床结果，以及使用供体淋巴细胞输注作为诱导移植后GvL的一种手段。
