单倍型供者淋巴细胞输注治疗复发性急性白血病

Treatment of relapsed acute leukemia by haplo-identical donor lymphocyte infusion

目的探讨难治性复发性急性白血病单倍型淋巴细胞输注的疗效。方法2006年4月至2007年10月应用单倍型淋巴细胞输注治疗复发性急性髓性白血病（AML）3例（M2 2例，M4 1例），复发性急性淋巴细胞白血病（ALL）1例，4例复发患者在二线方案化疗无效后，采集供者淋巴细胞，子女供父母3例，母供子1例，供者淋巴细胞在输注前，患者再次接受了不同方案的化疗，白细胞较低时输注供者的淋巴细胞，平均输注细胞2．3（1．4～3．1）×10^8／kg，输注前淋巴细胞接受了6—8Gy^60Coγ射线照射。结果3例AML患者1例获得了完全缓解（CR），2例有效，1例ALL无效。4例患者输注单倍型供者淋巴细胞后无移植物抗宿主病的发生，未出现严重的骨髓抑制，1例患者发生了带状疱疹病毒感染。结论单倍型供者淋巴细胞输注配合化疗对难治复发的AML有疗效，输注细胞的数量及照射的剂量需进一步探讨。

Objective To evaluate the effect of haploidentical lymphocyte infusion on refractory and relapse acute leukemia. Methods The haploidentical donor lymphocyte infusion was used to treat for relapse acute myeloid leukemia 3 patients （ M2 2 cases, M4 1case）, one relapse acute lymphocyte leukemia from April 2006 to October 2007. Four cases who had accepted secondly regimens were ineffective after relapse. Collecting donor lymphocytes, parents children as donor supply in 3 cases, mother as donor supply one case. Before donor lymphocyte infusion patients received chemotherapy of different regimens. Donor haploidentical lymphocytes irradiated by 6-8 Gy radial were infused when patients white cell count was at the lowest after the chemotherapy. The average of infusion cells was 2.3 （ 1.4-3.1）×10^8/kg. Results One patient acquired complete remission and two patients were effective in three relapse acute myeloid leukemia. It was ineffective in relapse acute lymphocyte leukemia. No transfusion related graft versus host disease was observed. One patient has had herpes zoster virus infection. Conclusion Haploidentical donor lymphocyte infusion with chemotherapy are effective for refractory and relapse in acute myeloid leukemia, but the infused cell quantity and irradiated dosage must be further discussed.