自体外周血造血干细胞移植术后免疫重建及免疫治疗的临床研究

Clinical efficacy of immune reconstitution and immunotherapy after autologous peripheral blood stem cell transplantation

目的 观察自体外周血造血干细胞移植术后免疫重建和免疫治疗情况。方法 选择 5 6例 2 0 0 1年 3月～ 2 0 0 3年 5月自体外周血干细胞移植患者 ,分别以血常规中淋巴细胞百分比、绝对计数 ,血清球蛋白含量 ,CD3+ 、CD4 + 、CD8+ 细胞百分比及CD4 + /CD8+ 为观察指标 ,监测移植后淋巴细胞数量和功能的恢复情况。以大剂量IL 2作为移植后免疫治疗药物 ,观察治疗后感染和本病复发情况。结果 移植前血清球蛋白含量、淋巴细胞百分比和计数与移植后 1个月存在显著性差异 ,而与移植后 3个月的统计结果无显著性差异。移植后 1个月CD8+ 淋巴细胞比例即恢复正常 ,但CD4 + 细胞明显低于正常 ,CD4 + /CD8+ 明显低于移植前。 5 6例患者中 12例死于感染和疾病复发 ,其余患者已无病存活 5～ 30个月 ,其中 6例患者出现带状疱疹感染 ,经抗病毒治疗后痊愈。结论 造血干细胞移植后 ,患者淋巴细胞计数及功能均较移植前明显减低。以IL 2为主的免疫治疗 ,作用较肯定 ,且无严重毒副作用 ,适于临床广泛应用。

Objective To study immune reconstitution and immunotherapy after autologous peripheral blood stem cell transplantation. Methods Fifty-six cases of patients after APBSCT were detected the count and proportion of lymphocyte, content of serum globulin, proportion of CD4 + and CD8 + lymphocyte and CD4 +/CD8 +.Meanwhile, they were treated with IL-2. Results There were significant differences in content of serum globulin,count and proportion of lymphocyte,proportion of CD3 +, CD4 + lymphocyte and CD4 +/CD8 + before and after APBSCT one month. The proportion of CD8 + lymphocyte increased quickly and came to the level before APBSCT after transplantation one month. Of the patients, twelve died of infection or disease relapse three to eighteen months post-transplantation, and other patients are still alive and disease-free survival for five to thirty months.Conclusion The count and function of lymphocyte have obvious reducction after APBSCT. High dose IL-2 has define therapeutic effect and no serious ill effect, fitted clinical widespread.