肿瘤抗原冲击的DC联合CIK细胞治疗复发性多发性骨髓瘤的疗效

Clinical study of combined immunotherapy with tumor antigen-pulsed dendritic cells and cytokine-induced killer cells for relapsed multiple myeloma

目的:观察树突状细胞(dendritic cells,DC)联合细胞因子诱导的杀伤(cytokine-induced killer,CIK)细胞治疗复发性多发性骨髓瘤(multiple myeloma,MM)的疗效以及安全性。方法:采集2005年3月至2014年10月江苏省中医院血液科收治的22例复发性MM患者的骨髓瘤细胞以及外周血单个核细胞,体外培养扩增自体DC-CIK细胞,然后回输治疗,对比治疗前后患者免疫指标及临床治疗效果。结果:DC联合CIK细胞治疗复发性MM总体疗效为,完全缓解(CR)2例,接近完全缓解(n CR)5例,部分缓解(PR)7例,轻微治疗反应(MR)3例,疾病进展(PD)5例,总体反应率(CR+n CR+PR)为63.64%(14/22)。DC-CIK细胞治疗后患者外周血T细胞亚群比例较治疗前无明显变化,差异无统计学意义(P>0.05);NK细胞百分率较治疗前明显上升[(22.26±9.67)%vs(12.61±8.78)%],差异有统计学意义(P<0.01);LDH含量[(166±41)%vs(112±21)%]和β2-MG含量[(5.11±2.33)%vs(2.65±1.61)%]较治疗前均有明显下降,差异有统计学意义(P<0.01)。结论:DC-CIK细胞联合治疗复发性MM具有较好的临床疗效,是一种安全、有效的治疗方法,有望进一步在骨髓瘤及其他B细胞肿瘤的临床治疗中得到应用。

Objective: To evaluate the clinical efficacy and safety of combined immunotherapy with dendritic cells( DCs) and cytokine-induced killer( CIK) cells in the treatment of relapsed multiple myeloma( MM). Methods: Bone marrow myeloma cells and peripheral blood mononuclear cells were collected from 22 cases of relapsed MM. The autologous DCs and CIK cells were amplified in vitro and used for reinfusion treatment. The clinical responses and immune parameters before and after the treatment were compared. Results: Among the 22 patients,2 had CR in response to the combined therapy,5 had n CR,7 had PR,3 had MR,and 5 had PD. Thus,the overall response rate( CR + n CR + PR) was63. 64%( 14 /22). After the treatment,the percentages of T cells subsets in peripheral blood did not change significantly( P > 0. 05),whereas the percentage of NK cells increased significantly( [22. 26 ± 9. 67]% vs [12. 61 ± 8. 78]%,P <0. 01). Furthermore,the blood levels of LDH( [166 ± 41]% vs [112 ± 21]%) and β2-MG( [5. 11 ± 2. 33]% vs[2. 65 ± 1. 61]%) were significantly improved following the immunotherapy( P < 0. 01). Conclusion: The combined therapy with DC and CIK cells are safe and effective for relapsed MM. The treatment should be further tried in more patients with multiple myeloma and perhaps patients with B cell malignancies.