Hamblin M, Marsh J C, Lawler M, McCann S R, Wickham N, Dunlop L, Ball S, Davies E G, Hale G, Waldmann H, Gordon-Smith E C
Department of Haematology and Child Health, St George's Hospital, London, UK.
Bone Marrow Transplant. 1996 May;17(5):819-24.
We have evaluated the effect of in vivo Campath-1G on engraftment and GVHD in 23 patients with severe aplastic anaemia transplanted from HLA-identical sibling donors. In 14 patients Campath 1g was given pre-transplant for up to 9 days in an attempt to overcome graft rejection (group 1). In nine patients Campath-1G was given pre-transplant, but also continued post-transplant until day +5 to reduce GVHD (group 2). There were three patients with late graft failure in group I following initial neutrophil engraftment, and four cases of grade II+ GVHD. In group II, two patients had early graft failure (no take), and there were no cases of acute GVHD out of seven evaluable patients. One patient in group I developed chronic GVHD of the liver, and two patients (one in each group) had transient localised chronic GVHD. PCR of short tandem repeats was used to evaluate chimaeric status in 13 patients. Of 11 patients with initial neutrophil engraftment, only one had 100% donor haemopoiesis at all times. The remaining patients had either transient mixed chimaerism or persistence of recipient (< 20%) cells. We conclude that in vivo Campath-1G is associated with a high incidence of mixed chimaerism which tips the balance away from GVHD but towards graft rejection.
我们评估了体内注射Campath-1G对23例接受来自HLA配型相同同胞供者移植的重型再生障碍性贫血患者植入和移植物抗宿主病（GVHD）的影响。14例患者在移植前给予Campath 1g，持续9天，试图克服移植排斥反应（第1组）。9例患者在移植前给予Campath-1G，且在移植后持续至+5天以减轻GVHD（第2组）。第1组中有3例患者在最初中性粒细胞植入后出现晚期移植失败，4例发生II+级GVHD。在第2组中，2例患者出现早期移植失败（未植入），7例可评估患者中无急性GVHD病例。第1组中有1例患者发生肝脏慢性GVHD，2例患者（每组各1例）出现短暂局限性慢性GVHD。应用短串联重复序列聚合酶链反应（PCR）评估了13例患者的嵌合状态。在11例最初中性粒细胞植入的患者中，只有1例在所有时间均有100%供者造血。其余患者要么出现短暂混合嵌合，要么存在受者细胞持续存在（<20%）。我们得出结论，体内注射Campath-1G与混合嵌合的高发生率相关，这使得平衡从GVHD转向移植排斥反应。
