异基因造血干细胞移植后白血病复发伴活动性移植物抗宿主病患者的临床研究

Clinical study on the relapsed leukemia patients with graft versus host disease after allogeneic hematopoietic stem cell transplantation

目的 探讨异基因造血干细胞移植（allo-HSCT）后白血病复发伴活动性移植物抗宿主病（GVHD）患者GVHD与GVL效应的分离.方法 分析11例接受allo-HSCT后在白血病复发时存在活动性GVHD的患者其原发病、疾病状态、复发时GVHD类型、供者淋巴细胞输注（DLI）疗效及转归等对GVL效应的影响.结果 11例患者包括急性淋巴细胞白血病5例,急性髓系白血病6例,其中5例曾行预防性DLI,复发时伴有活动性DLI后GVHD,包括2例Ⅱ度急性GVHD（aGVHD）,1例原局限型慢性GVHD（cGVHD）加重＋新发Ⅱ度aGVHD,2例广泛型cGVHD 这5例患者复发后,2例行化疗＋治疗性DLI,DLI后在广泛型cGVHD反复加重情况下,1例达完全缓解（CR）后再次复发,1例未达CR.另6例患者复发前未行预防性DLI,白血病复发时亦均存在活动性GVHD,包括3例广泛型cGVHD、1例Ⅰ度aGVHD及2例Ⅲ～Ⅳ度aGVHD,复发后行化疗＋治疗性DLI,之后2例达CR后再次复发,4例未达CR.结论 allo-HSCT后活动性GVHD不一定伴随可抑制白血病复发的有效GVL效应.

Objective To explore the dissociation of graft-versus-leukemia （GVL） effects from graftversus-host disease （GVHD） in the patients who experienced GVHD during leukemia relapse after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The primary disease, disease status,GVHD, response to donor lymphocyte infusion （DLI） and prognosis were analysed in 11 leukemia patients who relapsed with GVHD after allo-HSCT. Results Of the 11 relapsed, 5 were acute lymphoblastic leukemia and 6 acute myeloid leukemia. Five received DLI before relapse and all developed post-DLI GVHD, including 2 grade Ⅱ acute GVHD （aGVHD）, 1 limited chronic GVHD（cGVHD） plus grade Ⅱ aGVHD, and 2 extensive cGVHD. After relapse of the 5 patients, 2 received Chemo-DLI, one achieved CR with extensive cGVHD and then relapsed again, the other didn＇t achieved CR. The other 6 patients didn＇t received DLI before relapse and also developed post-HSCT GVHD while relapsing, including 3 extensive cGVHD, 1 grade ⅠaGVHD and 2 grade Ⅱ - Ⅳ aGVHD. After relapse, these 6 patients received Chemo-DLI, 2 achieved CR and then relapsed again, 4 didn＇t achieved CR. Conclusion The elicited GVHD after allo-HSCT may not accompany effective GVL effects inhibiting leukemic relapse.