异基因造血干细胞移植后监测患者不同免疫细胞亚群嵌合率的临床意义

Clinical significance on monitoring different immune cell chimerism of patients after allogeneic hematopoietic stem cell transplantation

目前,异基因造血干细胞移植(allo-HSCT)已被越来越广泛地应用于血液系统疾病及恶性实体肿瘤等的治疗。但患者接受allo-HSCT后亦存在一系列问题,如原发病复发、移植物排斥(GR)、移植物抗宿主病(GVHD)等,这可能导致移植失败,亦是目前影响allo-HSCT疗效的重要难题。动态监测供、受者不同免疫细胞亚群的嵌合状态,并且及时作出相应的临床处理,对减少疾病复发和GR,降低GVHD发生风险有重要意义。其中,T细胞的嵌合状态与移植后GVHD发生相关,患者移植早期的T细胞嵌合率越高,则越容易发生GVHD;B细胞的嵌合状态通常与allo-HSCT后复发有相关性。笔者主要就不同免疫细胞亚群嵌合率的监测,结合影响嵌合状态的因素,对动态监测嵌合率在allo-HSCT后的临床意义进行综述,从而进一步指导临床治疗和干预。

Allogeneic hematopoietic stem cell transplantation (allo-HSCT) has been widely used in the treatment of hematologic diseases and other malignant solid tumors. However, there are also a series of problems after allo-HSCT, such as the recurrence of the primary disease, graft rejection (GR), graft versus host disease(GVHD) and so on, which may lead to the failure of transplantation, and are currently important problems affecting the efficacy of allo-HSCT. Dynamic monitoring of chimeric state of donor and recipient cells and timely corresponding clinical treatment have great significance to reduce the recurrence of disease, GR and GVHD. The chimeric state of T cells is related to the occurrence of GVHD after transplantation, and the higher the chimeric rate of T cells in the early stage, the more likely GVHD will occur. The chimeric state of B cells is often correlated with the recurrence after transplantation. In this paper, the clinical significance of dynamic monitoring of chimeric rate of patients after allo-HSCT was elaborated from the monitoring of chimeric rate of different immune cell subgroups and the factors influencing chimeric state, so as to further guide clinical treatment and intervention.