体外光化学疗法治疗慢性移植物抗宿主病的研究进展

Advances on Extrocorporeal Photochemotherapy in the Treatment of Chronic Graft-Versus-Host Disease——Review

慢性移植物抗宿主病(c GVHD)是异基因造血干细胞移植后的主要并发症及导致患者死亡的主要原因之一。体外光化学疗法(extracorporeal photochemotherapy,ECP)已成为治疗c GVHD的一种有效手段,它是用长波紫外线照射患者的单个核细胞与光敏剂8-甲氧基补骨脂素的混合并回输至患者体内达到治疗疾病的目的。ECP治疗作用主要是通过诱导细胞凋亡、影响树突状细胞的功能及诱导免疫耐受等来实现的。它具有不增加患者的感染风险,不影响移植物抗白血病效应和副作用小等诸多优点。国外很多医学中心对ECP治疗成人及儿童c GVHD展开了大量研究,在临床上取得了较好的疗效。CD19+CD21-B淋巴细胞、血清BAFF及血清TNFα可用于衡量及早期评价ECP的治疗疗效。ECP的疗效与诸多因素相关,在治疗过程中会出现若干并发症。由于目前ECP治疗机制尚未完善明确,诸多研究治疗周期长短不一,临床研究病人例数较少等原因在一定程度上限制了其推广应用。相信在不久的将来,随着基础研究的深入、临床样本量的增多及治疗周期的规范,ECP会具有更加广泛的应用前景。本文主要针对ECP治疗c GVHD的相关研究进展展开论述。

Chronic graft-versus-host disease( c GVHD) is a common complication after allogeneic hematopoietic stem cell transplantation( allo-HSCT),which is also one of the major causes of patients' death following transplantation.Recently,extracorporeal photochemotherapy( ECP) has shown a considerable efficacy in c GVHD treatment,which is based on the infusion of autologous peripheral blood mononuclear cells collected by aphesis, incubated with the photoactivable drug 8-methoxypsoralen( 8-M OP) and UV-A irradiation. The therapeutic effect of ECP is mainly achieved by the induction of cell apoptosis,influencing the function of dendritic cells and the induction of immune tolerance. ECP has many advantages in the treatment of c GVHD,such as no increasing the risk of infection in patients,unaffecting the graft-versus-leukemia effect,nearly no side effect and so on. M any medical centers have done a lot of research on the treatment of c GVHD in both children and adults by using ECP and achieved good results. CD19+CD21-B lymphocytes,serum BAFF and serum TNFα can be used to measure and early evaluate the efficacy of ECP treatment.The effect of ECP is associated with many factors,and certain complications may occur during the treatment. At present,the application of ECP treatment is limited by the unclear mechanisms,varying treatment cycles in different studies,and small number of patients in clinical research. In the near future,with deeper basic research,increasing the case number and standard clinical treatment,ECP will have a more extensive application prospects. This reviewfocuses mainly on the clinical advances of ECP in the treatment of c GVHD.