中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2008年
10期
667-671
,共5页
蒋瑛%万理萍%王椿%颜式可%高彦荣%姜杰玲%杨隽%蔡宇%白海涛%魏道林%谢匡成
蔣瑛%萬理萍%王椿%顏式可%高彥榮%薑傑玲%楊雋%蔡宇%白海濤%魏道林%謝劻成
장영%만리평%왕춘%안식가%고언영%강걸령%양준%채우%백해도%위도림%사광성
造血干细胞移植%短串联重复序列%嵌合状态%移植物抗宿主病%复发
造血榦細胞移植%短串聯重複序列%嵌閤狀態%移植物抗宿主病%複髮
조혈간세포이식%단천련중복서렬%감합상태%이식물항숙주병%복발
Hematopoietic stem cell transplantation%Short tendem repeat%Chimerism%Graft versus host disease%Relapse
目的 研究异基因造血干细胞移植(allo-HSCT)后各系细胞嵌合状态与移植物植入、急性移植物抗宿主病(aGVHD)、移植物被排斥和疾病复发的关系.方法 对65例患者进行allo-HSCT,在移植后定期采集所有患者的外周血和骨髓.用流式细胞术分选了65例患者的CD3+T淋巴细胞,52例分选了CD3-CD56+CD16+NK细胞,32例分选了CD15+粒细胞,20例分选了CD19+B淋巴细胞.进行PCR扩增短串联重复序列检测各系细胞嵌合状态.结果 移植后NK细胞早期植入比例(55.5%)最高,T细胞最晚(+21 d)达到完全供者嵌合状态.+7 d T淋巴细胞供者嵌合比例(DC)≥70%和+14 d T淋巴细胞DC≥95%属aGVHD发生的高危患者.除急性淋巴细胞白血病外,出现移植物被排斥的分子生物学征象者和疾病复发者,都以T淋巴细胞供者嵌合状态下降为主.在过继免疫治疗中,动态检测嵌合状态可以判断疗效和指导进一步的治疗.结论 allo-HSCT后T淋巴细胞嵌合状态动态检测可以早期预测发生aGVHD的高危患者、判断移植物植入、发现移植物被排斥和疾病复发并指导免疫调节治疗的时机和疗效.
目的 研究異基因造血榦細胞移植(allo-HSCT)後各繫細胞嵌閤狀態與移植物植入、急性移植物抗宿主病(aGVHD)、移植物被排斥和疾病複髮的關繫.方法 對65例患者進行allo-HSCT,在移植後定期採集所有患者的外週血和骨髓.用流式細胞術分選瞭65例患者的CD3+T淋巴細胞,52例分選瞭CD3-CD56+CD16+NK細胞,32例分選瞭CD15+粒細胞,20例分選瞭CD19+B淋巴細胞.進行PCR擴增短串聯重複序列檢測各繫細胞嵌閤狀態.結果 移植後NK細胞早期植入比例(55.5%)最高,T細胞最晚(+21 d)達到完全供者嵌閤狀態.+7 d T淋巴細胞供者嵌閤比例(DC)≥70%和+14 d T淋巴細胞DC≥95%屬aGVHD髮生的高危患者.除急性淋巴細胞白血病外,齣現移植物被排斥的分子生物學徵象者和疾病複髮者,都以T淋巴細胞供者嵌閤狀態下降為主.在過繼免疫治療中,動態檢測嵌閤狀態可以判斷療效和指導進一步的治療.結論 allo-HSCT後T淋巴細胞嵌閤狀態動態檢測可以早期預測髮生aGVHD的高危患者、判斷移植物植入、髮現移植物被排斥和疾病複髮併指導免疫調節治療的時機和療效.
목적 연구이기인조혈간세포이식(allo-HSCT)후각계세포감합상태여이식물식입、급성이식물항숙주병(aGVHD)、이식물피배척화질병복발적관계.방법 대65례환자진행allo-HSCT,재이식후정기채집소유환자적외주혈화골수.용류식세포술분선료65례환자적CD3+T림파세포,52례분선료CD3-CD56+CD16+NK세포,32례분선료CD15+립세포,20례분선료CD19+B림파세포.진행PCR확증단천련중복서렬검측각계세포감합상태.결과 이식후NK세포조기식입비례(55.5%)최고,T세포최만(+21 d)체도완전공자감합상태.+7 d T림파세포공자감합비례(DC)≥70%화+14 d T림파세포DC≥95%속aGVHD발생적고위환자.제급성림파세포백혈병외,출현이식물피배척적분자생물학정상자화질병복발자,도이T림파세포공자감합상태하강위주.재과계면역치료중,동태검측감합상태가이판단료효화지도진일보적치료.결론 allo-HSCT후T림파세포감합상태동태검측가이조기예측발생aGVHD적고위환자、판단이식물식입、발현이식물피배척화질병복발병지도면역조절치료적시궤화료효.
Objective To evaluate the relationship of chimerism status of cell subsets with engraftment, occurrence of acute graft versus host disease (aGVHD), graft rejection and disease relapse after aliogenieic hematopoietic stem cell transplantation (allo-HSCT). Methods Chimerism status in peripheral blood (PB) and bone marrow (BM) of 65 patients received allo-HSCT were monitored at regular intervals posttransplant. Fluorescence-activated cell sorter (FACS) was used to sort CD3+ T lymphocytes in 65 cases, CD3- CD56+ CD16+ NK cells in 52 cases, CD15+ granulocytes in 32 cases and CD19+ B lymphocytes in 20 cases post transplants. The chimerism status of different lineage cells was analyzed by polymerase chain reaction amplification of short tandem repeats (PCR-STR). Results On day + 7, NK-cells donor chimerism (DC 55.5%)was higher than other cell subsets. T lymphocyte was the latest one to reach complete donor chimerism(CDC) with a median on day + 21. Patients whose T lymphocytes donor chimerism was more than 70% on day +7 and more than 95% on day + 14 had a high risk for acute aGVHD. In all cases except those with ALL, the decreased DC of T lymphocytes were observed before molecular or hematological relapse occurred. Conclusion Serial and quantitative T cell chimerism analysis provides a reliable and rapid screening method for the early detection of engraftment, graft rejection, disease relapse and occurrence of aGVHD, therefore, is a prognostic tool to identify patients at high risk of aGVHD and disease relapse following alloHSCT.
