慢性髓系白血病患者同种异基因外周血干细胞移植后复发时停用CsA逆转嵌合体2例

Reversing of Donor Chimeras by Stopping Use of CsA in 2 CML Patients Relapsed after transplantation

本研究探讨慢性髓系白血病患者移植后复发时停用环孢菌素A(CsA)对逆转供者型嵌合体的作用。对2例CML进行了同种异基因外周血干细胞移植术(allo-PBSCT),术后出现嵌合体下降,融合基因和(或)染色体阳性,疾病复发,治疗中停用CsA,密切观察体温、皮疹、血象、肝功能及嵌合体。结果表明:2例患者均出现急性GVHD表现,复查嵌合体表明2例均回复到100%供者型嵌合体,融合基因和或染色体转阴。结论:患者在移植后复发,通过停用CsA诱发GVHD以发挥GVL作用,使供者嵌合体逆转,对复发的治疗有一定作用。

The purpose of study was to evaluate the effect of stopping use of cyclosporine A （CsA） in reversion of donor chimeras of chronic myeloid leukemia （CML） patients relapsed after transplantation. Two CML patients were transplantated with allogeneic peripheral blood stem cells, and relapsed after transplantation, their bcr/abl gene and/or phl chromosome showed positive, donor chimeras decreased. For these two CML patients relapsed after transplantation, the use of CsA was stoped immediately, and the patient＇s body temperature, skin rash, blood picture, liver function and chimeras were planed to observe carefully. The results indicated that acute graft versus host disease （aGVHD） appeared in both patients. A hundred percent （ 100% ）of donor chimeras were then found with bcr/abl gene and/or phi chromosome turning to negative in both patients. In conclusion, to stop using of CsA might be effective in the treatment of some CML patients relapsed after transplantation by reversing of donor chimeras and inducing graft-versus-leukemia （GVL） effect accompanied by GVHD.