Donor-Derived CD19-Targeted T Cell Infusion Eliminates B Cell Acute Lymphoblastic Leukemia Minimal Residual Disease with No Response to Donor Lymphocytes after Allogeneic Hematopoietic Stem Cell Transplantation

Leukemia relapse is still the leading cause of treatment failure after allogeneic hematopoietic stem cell transplantation (allo-HSCT) for B cell acute lymphoblastic leukemia (B-ALL). Relapsed patients with BALL after allo-HSCT have a very short median survival. Minimal residual disease (MRD) is predictive of forthcoming hematological relapse after hematopoietic stem cell transplantation (HSCT);furthermore, eliminating MRD effectively prevents relapse. Donor lymphoblastic infusion (DLI) is the main established approach to treat B-ALL with MRD after allo-HSCT. However, about one-third of patients with MRD are non-responsive to DLI and their prognosis worsens. Although donor-derived cluster of differentiation (CD)19-directed chimeric antigen receptor-modified (CAR) T cells (CART19s) can potentially cure leukemia, the efficiency and safety of infusions with these cells have not yet been investigated in patients with MRD after HSCT. Between September 2014 and February 2018, six patients each received one or more infusions of CART19s from HSCT donors. Five (83.33%) achieved MRD-negative remission, and one case was not responsive to the administration of CAR T cells. Three of the six patients are currently alive without leukemia. No patient developed acute graft-versus-host disease (aGVHD), and no patient died of cytokine release syndrome. Donor-derived CAR T cell infusions seem to be an effective and safe intervention for patients with MRD in B-ALL after allo-HSCT and for those who were not responsive to DLI.

Resveratrol Induces Apoptosis and Autophagy in T-cell Acute Lymphoblastic Leukemia Cells by Inhibiting Akt/mTOR and Activating p38-MAPK

Objective To explore the effects of resveratrol-induced apoptosis and autophagy in T-cell acute lymphoblastic leukemia （T-ALL） cells and potential molecular mechanisms. Methods The anti-proliferation effect of resveratrol-induced, apoptosis and autophagy on T-ALL cells were detected by using MTI- test, immunofluorescence, electronic microscope, and flow cytometry, respectively. Western blotting was performed for detecting changes of apoptosis-associated proteins, cell cycle regulatory proteins and state of activation of Akt, mTOR, p70S6K, 4E-BP1, and p38-MAPK. Results Resveratrol inhibited the proliferation and dose and time-dependent manner. It also induced cyclin-dependent kinase （CDK） inhibitors p21 and induced apoptosis and autophagy in T-ALL cells in a cell cycle arrest at G0/G1 phase via up regulating p27 and down regulating cyclin A and cyclin D1. Western blotting revealed that resveratrol significantly decreased the expression of antiapoptotic proteins （Mcl-1 and Bcl-2） and increased the expression of proapoptotic proteins （Bax, Bim, and Bad）, and induced cleaved-caspase-3 in a time-dependent manner. Significant increase in ratio of LC3-11/LC3-1 and Beclin 1 was also detected. Furthermore, resveratrol induced significant dephosphorylation of Akt, mTOR, p70S6K, and 4E-BP1, but enhanced specific phosphorylation of p38-MAPK which could be blocked by SB203580. When autophagy was suppressed by 3-MA, apoptosis in T-ALL cells induced by resveratrol was enhanced. Conclusion Our findings have suggested that resveratrol induces cell cycle arrest, apoptosis, and autophagy in T-ALL cells through inhibiting Akt/mTOR/p7OS6K/4E-BP1 and activating p38-MAPK signaling pathways. Autophagy might play a role as a self-defense mechanism in T-ALL cells treated by resveratrol. Therefore, the reasonable inhibition of autophagy in T-ALL cells may serve as a promising strategy for resveratrol induced apoptosis and can be used as adjuvant chemotherapy for T-ALL.

Establishment of Reproducible Xenotransplantation Model of T Cell Acute Lymphoblastic Leukemia in NOD/SCID Mice

T cell acute lymphoblastic leukemia(T-ALL) is an aggressive leukemia.However the poor prognosis and low morbidity restrict further analysis of the disease.Therefore there is an increasing demand to develop animal models for identifying novel therapeutic approaches.In this study,we inoculated the anti-mouse CD122 monoclonal antibody conditioned NOD/SCID mice with the leukemia cells from 9 T-ALL patients and 1 cell line via the tail vein.Four of the 9 patients and the cell line were successfully engrafted.Flow cytometry detected high percentage of human CD45 + cells in recipient mice.Immunohistochemistry showed infiltration of human CD45 + cells in different organs.Serial transplantation was also achieved.In vivo drug treatment showed that dexamethasone could extend survival,which was consistent with clinical observation.These results demonstrated that we successfully established 5 xenotransplantation models of T-ALL in anti-mCD122 mAb conditioned NOD/SCID mice,which recapitulated the characteristics of original disease.

A facile,branched DNA assay to quantitatively measure glucocorticoid receptor auto-regulation in T-cell acute lymphoblastic leukemia

Glucocorticoid(GC) steroid hormones are used to treat acute lymphoblastic leukemia(ALL) because of their pro-apoptotic effects in hematopoietic cells.However,not all leukemia cells are sensitive to GC,and no assay to stratify patients is available.In the GC-sensitive T-cell ALL cell line CEM-C7,auto-up-regulation of RNA transcripts for the glucocorticoid receptor(GR) correlates with increased apoptotic response.This study aimed to determine if a facile assay of GR transcript levels might be promising for stratifying ALL patients into hormone-sensitive and hormone-resistant populations.The GR transcript profiles of various lymphoid cell lines and 4 bone marrow samples from patients with T-cell ALL were analyzed using both an optimized branched DNA(bDNA) assay and a real-time quantitative reverse transcription-polymerase chain reaction assay.There were significant correlations between both assay platforms when measuring total GR(exon 5/6) transcripts in various cell lines and patient samples,but not for a probe set that detects a specific,low abundance GR transcript(exon 1A3).Our results suggest that the bDNA platform is reproducible and precise when measuring total GR transcripts and,with further development,may ultimately offer a simple clinical assay to aid in the prediction of GC-sensitivity in ALL patients.

ATP binding cassette C1 (ABCC1/MRP1)-mediated drug efflux contributes to disease progression in T-lineage acute lymphoblastic leukemia

Purpose: In acute lymphoblastic leukemia (ALL), multidrug resistance is often mediated by AT- Pase Binding Cassette (ABC) proteins, which principally involve ABCC1 (multidrug resistance protein 1, MRP1) and ABCB1 (multidrug resistance 1, MDR1). However, direct comparisons between the differential effects of ABCC1 and ABCB1 have been difficult, since identical cell lines with differential expression of these transporters have not been developed. Experimental Design: In this study, we developed and compared the biological profiles of Jurkat cell lines that selectively over-expressed ABCC1 and ABCB1. Vincristine (VCR) plays an important role in the treatment of T-lineage ALL (T-ALL), and is often the first drug given to newly-diagnosed patients. Because of its importance in treatment, we provide descalating, sub-lethal doses of VCR to Jurkat cells, and extended our observations to expression profiling of newly diagnosed patients with T-ALL. Results: We found that VCR-resistant cells over-expressed ABCC1 nearly 30-fold. The calcein AM assay confirmed that VCR-resistant cells actively extruded VCR, and that ABCC1-mediated drug resistance conferred a different spectrum of multidrug resistance than other T-ALL induction agents. siRNA experiments that blocked ABCC1 export confirmed that VCR resistance could be reversed in vitro. Analyses of T-lymphoblasts obtained from 100 newly diagnosed T-ALL patients treated on Children’s Oncology Group Phase III studies 9404 and AALL0434 that induction failure could be could be partially explained by the over-expression of ABCC1 and ABCB1. Conclusions: Taken together, these results suggest that over-expression of ABC transporters plays a contributing role in mediating treatment failure in T-ALL, and underscore the need to employ alternate treatment approaches in patients for whom induction failed or for those with relapsed disease.

Rearranged Patterns of IgH and TcRγ Genes in Patients with Acute Lymphoblastic Leukemia

The rearrangement of immunoglobulin heavy chain gene(IgH) and T cell receptor γgene (ToRγ)was studied in 30 patients with acute lymphoblastic leukemia(ALL) by the polymerase chain reaction (PCR). 19 cases was found to have rearrangement of IgH gene,12 of TcRγ. Most of IgH rearrangement was characterized by one or two specific bands while some had more than two. Rearrangement of TcRγgene appeared as one specific band. A slight difference in number, size and lightness of bands was found among the patients. 4 different kinds of rearrangement were observed in the detection of IgH rearrangement in combination with TcRγgene. The rearranged patterns of IgH and TcRγgene as well as the clinical significance were discussed.

The Role of Mitochondrial VDAC2 in the Survival and Proliferation of T-Cell Acute Lymphoblastic Leukemia Cells

Background: T-cell acute lymphoblastic leukemia (T-ALL) is an aggressive hematological malignancy with aberrant T-cell developmental arrest. Individuals with relapsed T-ALL have limited therapeutic alternatives and poor prognosis. The mitochondrial function is critical for the T-cell viability. The voltage-dependent anion channel 2 (VDAC2) in the mitochondrial outer membrane, interacts with pro-apoptotic BCL-2 proteins and mediates the apoptosis of several cancer cell lines. Objective: The aim of the current study is to explore the role of VDAC2 in T-ALL cell survival and proliferation. Methods: Publicly available datasets of RNA-seq results were analyzed for expression of VDAC isoforms and T-ALL cell lines were treated with a VDAC2 small molecular inhibitor erastin. A VDAC2 RNA interference (siRNA) was delivered to T-ALL cell lines using a retroviral vector. Functional assays were performed to investigate the VDAC2 siRNA impacts on cell proliferation, apoptosis and survival of T-ALL cells. Results: Our analysis found a high expression of VDAC2 mRNA in various T-ALL cell lines. Public datasets of T-ALL RNA-seq also showed that VDAC2 is highly expressed in T-ALL (116.2 ± 36.7), compared to control groups. Only two T-ALL cell lines showed sensitivity to erastin (20 μM) after 48 hours of incubation, including Jurkat (IC50 = 3.943 μM) and Molt4 (IC50 = 3.286 μM), while another two T-ALL cells (CUTLL1 and RPMI 8402) had unstable IC50. However, five T-ALL cell lines (LOUCY, CCRF-CEM, P12-ICHI, HPB-ALL, and PEER cells) showed resistance to erastin. On the contrary, all T-ALL cell lines genetically inhibited with VDAC2 siRNA led to more than 80% decrease in VDAC2 mRNA levels, and a Conclusion: VDAC2 is highly expressed in T-ALL cells. The inhibition of VDAC2 significantly decreased cell viability, increased apoptosis, reduced cell proliferation and caused cell cycle sub-G1 arrest of T-ALL cells.

Adult Acute T Cell Leukemia Presenting as Acute Renal Failure, Parotid Swelling and Loss of Vision

A rare case of T cell acute lymphoblastic leukemia presenting with loss of vision, parotid swelling, hematuria and acute renal failure has been presented in a 40-year-old male. Acute T cell Lymphoblastic Leukemia should also be kept in differential diagnosis of hematuria, acute renal failure and loss of vision.

盐酸青藤碱抑制急性T淋巴细胞白血病CEM细胞株的作用及转录组学分析

背景:盐酸青藤碱有抗多种肿瘤的作用,但目前尚不清楚盐酸青藤碱对急性T淋巴细胞白血病的作用。目的:探讨盐酸青藤碱对急性T淋巴细胞白血病CEM细胞的抑制作用。方法:应用不同浓度(0.5,1,2,4 mmol/L)盐酸青藤碱处理CEM细胞,CCK-8检测细胞增殖抑制率并计算IC50;倒置显微镜和吉姆萨染色观察CEM细胞形态变化;利用RNA-Seq测序分析差异基因表达并进行生物信息学分析。结合转录组测序结果,流式细胞术检测不同浓度(1,2,4 mmol/L)盐酸青藤碱作用后CEM细胞凋亡率;Western blot检测不同浓度(1,2,4 mmol/L)盐酸青藤碱作用后CEM细胞中Bcl-2、Bax、Caspase-9蛋白的表达。结果与结论:①盐酸青藤碱呈剂量和时间依赖性地抑制CEM细胞生长;②盐酸青藤碱干预后CEM细胞数量下降,核固缩;③RNA-seq测序筛出53个异常表达基因,基因本体分析主要富集在细胞过程、细胞解剖实体与粘连关系等,信号通路分析与肿瘤相关的是细胞凋亡;④盐酸青藤碱呈剂量依赖性地促进CEM细胞凋亡;⑤盐酸青藤碱上调CEM细胞中Bax、Caspase-9蛋白表达,下调Bcl-2蛋白表达。由此可见,盐酸青藤碱可诱导CEM细胞凋亡从而抑制细胞增殖,可能与其上调Bax和Caspase-9蛋白表达,以及下调Bcl-2蛋白表达有关。

GAS2增强CXCR4蛋白稳定性并促进T-ALL细胞的生长

目的研究生长抑制特异蛋白GAS2(growth arrest-specific 2)在急性T淋巴细胞白血病(T-cell acute lymphoblastic leukemia,T-ALL)细胞体内外生长和迁移中的功能,并初探其作用机制。方法(1)以MOLT-4细胞为模型,研究过表达GAS2对这些细胞的生长、集落生成、迁移和体内成白血病能力的影响;(2)利用RT-qPCR、Western blot和流式细胞术研究GAS2对CXCR4表达的影响;(3)在过表达GAS2的MOLT-4细胞中沉默CXCR4,研究CXCR4在GAS2促进T-ALL细胞生长功能中的作用。结果(1)过表达GAS2显著增强MOLT-4细胞的生长、集落生成和迁移能力;(2)过表达GAS2增强MOLT-4细胞在免疫缺陷小鼠体内的成白血病的能力;(3)GAS2增强CXCR4的蛋白表达、细胞膜表达和稳定性,但不影响它的mRNA表达;(4)CXCR4沉默能逆转过表达GAS2所导致的MOLT-4细胞生长增快。结论GAS2可部分通过增强CXCR4的蛋白稳定性而促进T-ALL细胞的生长。该研究增进了对T-ALL分子致病机制的认知,有望为疾病治疗提供新思路。

T-ALL及T细胞株相关TCR Vβ基因谱系和克隆性分析

目的 了解T细胞 急性淋巴细胞白血病 (T ALL)患者外周血中的T细胞及T细胞株的TCRVβ基因谱系及其克隆性增殖情况。方法 利用RT PCR方法扩增 6个不同的T细胞株和 6例初发未治T ALL病人外周血单个核细胞中 2 4个TCRVβ基因的互补决定区 3(CDR3) ,PCR产物进一步经荧光标记和基因扫描分析CDR3长度而确定T细胞的克隆性 ,部分T细胞株的单克隆PCR产物进一步进行序列分析。结果 与正常人外周血表达全部 2 4个Vβ亚家族不同 ,6例T ALL病人分别表达 5～ 12个Vβ亚家族。 6例病人均存在 1个或多个Vβ亚家族的寡克隆或双克隆增殖T细胞 ,另外 ,还有一些Vβ亚家族多克隆模式发生改变 ,呈现寡克隆性增殖的趋势。T细胞株多显示为表达一个Vβ亚家族的单克隆T细胞 ,不同T细胞株的CDR3长度和序列不尽相同。结论 T ALL患者外周血T细胞的TCRVβ谱系出现限制性改变 ,均可检测到克隆性增殖T细胞 ,尚需进一步鉴定其性质 (肿瘤性或抗原特异性增殖 ) 。

Notch1基因在T-ALL患者中的表达及其对NF-κB通路的影响

目的:探讨Notch1基因在急性T淋巴细胞白血病(T-ALL)患者外周血单个核细胞(PBMC)中的表达及其对NF-κB通路的作用。方法:选取T-ALL患者67例作为试验组,以67例健康体检者作为对照。采用qRT-PCR分析PBMC中Notch1和NF-κB通路(IκBα、IKKβ)mRNA表达量,分析Notch1的表达水平与T-ALL患者临床指标和预后之间的关联,以及Notch1与NF-κB通路mRNA表达水平的关联。沉默Jurkat细胞中的Notch1基因,qRT-PCR分析Notch1、IκBα和IKKβ mRNA表达,Western blot分析Notch1、磷酸化IκBα(p-IκBα)和磷酸化IKKβ(p-IKKβ)蛋白表达。结果:T-ALL组PBMC中Notch1 mRNA表达水平高于健康组,差异有统计学意义(P<0.05)。Notch1表达水平与LDH水平、白细胞水平和危险度分级之间呈显著正相关(r=0.102,P=0.025;r=0.247,P=0.019;r=0.429,P=0.006),而与年龄和性别无显著相关性。Notch1与IκBα mRNA水平呈显著负相关(r=-0.754,P=0.039),与IKKβ mRNA水平呈显著正相关(r=0.738,P=0.002)。Notch1低表达组中位总生存时间为(18.5±2.2)个月,显著长于高表达组的(12.7±3.4)个月(χ;=1.677,P=0.038)。沉默Notch1可显著上调IκBα mRNA和p-IκBα蛋白水平(P<0.05),显著下调IKKβ mRNA和p-IKKβ蛋白水平(P<0.05)。结论:Notch1基因在T-ALL患者血浆PBMC中高表达,与患者LDH水平、白细胞水平和危险度分级等临床指标和生存率相关,Notch1可能通过NF-κB通路发挥作用。

T-ALL患者骨髓CD_(34)^+细胞的Hes1基因表达、数量、增殖变化及机制探讨

目的观察急性T淋巴细胞白血病(T-ALL)患者骨髓CD+34细胞Hes1基因表达、数量、增殖的变化,并探讨其机制。方法收集8例初治T-ALL患者及4例正常供者(健康对照)骨髓样本,real time PCR检测Hes1基因的表达,密度梯度离心法获取单个核细胞,流式细胞术检测CD+34细胞比例及其细胞周期,免疫磁珠法分选CD+34细胞,体外集落形成实验(CFC)检测其增殖能力。构建Hes1基因过表达逆转录病毒载体,感染正常供者骨髓CD+34细胞后,流式细胞术分析其细胞周期的改变,CFC检测其增殖的改变。结果 T-ALL患者、健康对照CD+34细胞Hes1基因表达分别为3.3±0.8、1,两者比较,P<0.05;CD+34细胞比例分别为0.02%±0.003%、0.06%±0.005%,两者比较,P<0.05;CD+34细胞处于S期的细胞比例分别为16.2%±0.98%、28.0%±1.12%,两者比较,P<0.05;G0期比例分别为19.0%±0.9%、9.0%±0.5%,两者比较,P<0.05;且患者来源CD+34细胞的体外集落形成减少。提高正常CD+34细胞中Hes1基因的表达后,细胞增殖减少,进入静止期。结论 T-ALL患者CD+34细胞比例下降,进入静止期,体外扩增能力下降,这可能与Hes1基因的表达上调有关。

miR-935在Notch1介导的儿童T-ALL中的作用机制研究

目的:探讨miR-935在Notch1介导儿童T淋巴细胞白血病(T-ALL)中的作用机制。方法:通过荧光素酶报告实验验证Notch1是miR-935的靶基因。培养T-ALL细胞并进行分组处理,分别为对照组、miR-935过表达组、miR-935沉默组、Notch1过表达组及Notch1沉默组。检测各组细胞增殖、周期以及凋亡情况。RT-PCR实验检测miR-935在各组细胞中的表达,Western blot检测各组Notch1蛋白表达情况。结果:通过miRWalk预测和报告基因实验可知,Notch1为miR-935的靶基因。对照组、miR-935过表达组、miR-935沉默组、Notch1过表达组、Notch1沉默组的细胞抑制率分别为100.00%、(45.92±5.13)%、(104.03±2.11)%、(105.29±1.53)%、(44.63±3.27)%;细胞凋亡率分别为(8.12±1.43)%、(35.13±5.67)%、(4.08±1.25)%、(3.77±0.98)%、(36.08±6.32)%;与对照组相比,miR-935过表达和Notch1沉默组G0/G1期细胞明显增加,另外两组G0/G1期明显减少(P<0.05)。RT-PCR和Western blot实验表明,与对照组相比,miR-935过表达组miR-935表达上升,Notch1含量显著减少;miR-935沉默组miR-935表达减少,Notch1含量显著提升;Notch1过表达和沉默组miR-935表达无明显变化,但过表达组Notch1蛋白水平显著上升,沉默组Notch1蛋白水平显著下降。结论:miR-935过表达可有效抑制T-ALL细胞增殖,阻滞细胞周期并促进T-ALL细胞凋亡,具有较好的抗肿瘤效果,其作用机制可能是通过调控Notch1并最终介导T-ALL细胞活动。

Notch1活化型突变诱导T-ALL发病的研究进展

急性T淋巴细胞白血病(T-cell acute lymphoblastic leukemia,T-ALL)是我国儿童和青少年常见的恶性疾病之一,其进展迅速,病死率高。1991年,首次在伴有t(7;9)转位的T-ALL中发现Notch1的一类活化型突变,在此后至今的近20年里,对活化型Notch1突变与T-ALL发病之间关系的理解进一步深入。本文就活化型Notch1突变影响正常信号转导过程和基因表达、继而诱导T-ALL发病的机制研究进展作一综述。

T-ALL/淋巴瘤中BCL11B基因转录本的分析

目的:分析T-ALL/淋巴瘤中BCL11B基因转录本的特点。方法:利用逆转录聚合酶链式反应(RT-PCR)和实时定量聚合酶链式反应(RQ-PCR)方法分析12例T-ALL/淋巴瘤外周血单个核细胞(PBMC)中BCL11B基因的表达情况;限制性内切酶消化确定PCR产物的特异性。结果:3例T-ALL/淋巴瘤患者中出现2种BCL11B转录本:野生型和第3外显子缺失型,其余9例均表达第3外显子缺失型的转录本。两组病人PBMC中BCL11B表达水平无显著差别(P=0.301)。结论:3例T-ALL/淋巴瘤病人中存在2种BCL11B基因转录本,但在表达水平上无明显差别。

IGLL1基因在儿童T-ALL中的表达及临床意义

目的:检测儿童T系急性淋巴细胞白血病(T-ALL)患者骨髓标本中IGLL1(immunoglobulin lambda-like polypeptide 1)m RNA的相对表达量,并与儿童T-ALL的临床特征及预后进行相关分析,明确IGLL1在儿童T-ALL中的临床意义。方法:选取2012年6月至2017年12月期间就诊于苏州大学附属儿童医院的初诊T-ALL且接受CCLG-ALL 2008方案治疗的患儿56例。采用转录组测序技术检测T-ALL患儿中IGLL1基因的转录水平,按照IGLL1转录水平的25%(cutoff value:448)将患儿分为IGLL1低表达组(17例)和IGLL1高表达组(39例)。结合临床资料,分析IGLL1在T-ALL患儿中的表达水平与预后的相关性。结果:IGLL1的转录水平与患儿性别、年龄、骨髓原始细胞数、初诊白细胞(WBC)数等临床特点没有相关性,IGLL1高表达组患者较IGLL1低表达组患者5年总生存率明显提高(76.9%±6.7%vs 47.1%±12.1%,P=0.018)。进一步比较IGLL1高表达患者与低表达患者的无复发生存率(RFS),发现IGLL1高表达组患者5年无复发生存率要高于IGLL1低表达组(80.6%±6.6%vs 54.9%±14.0%),但两组间无复发生存率差异无统计学意义(P=0.095)。将临床常见预后因素(年龄、性别、初诊WBC计数、强的松D7th治疗反应、治疗后D15th骨髓反应情况)及IGLL1表达水平进行多因素COX分析,结果显示,IGLL1表达量(P=0.012)和强的松治疗反应(P=0.017)是影响儿童T-ALL患者总体生存的独立危险因素。结论:在儿童T-ALL中,IGLL1基因高表达组患儿的总生存率明显高于低表达组患儿,且IGLL1基因表达水平是影响儿童T-ALL患者生存的独立因素,提示IGLL1是儿童T-ALL患儿临床预后良好的指标。

儿童急性早幼粒细胞白血病治疗后继发T淋巴母细胞淋巴瘤1例临床报告

目的总结急性白血病治疗后继发非霍奇金淋巴瘤患儿的临床诊治过程,探讨疾病相关机理。方法回顾性分析1例急性早幼粒细胞白血病(APL)治疗后继发T淋巴母细胞淋巴瘤(T-LBL)患儿的临床资料,并检索急性白血病治疗后继发非霍奇金淋巴瘤的文献报告进行总结。结果患儿,男,10岁,因“间断发热”起病,确诊APL后,在治疗过程中出现骨髓复燃,调整治疗方案后达完全缓解,然而在结束白血病治疗后因淋巴结肿大诊断为T-LBL,经规范化疗再次得以缓解。检索近10年文献,急性白血病治疗后继发非霍奇金淋巴瘤共报告9例,均为成人病例,其中6例患者至报告时均为无病生存状态。结论急性白血病治疗后继发非霍奇金淋巴瘤的发生率低、预后较好。此外,对肿瘤性疾病化疗后的患者,需注意继发性肿瘤的发生,应用先进检测技术可提高对继发性肿瘤致病机制的认知。

RNA干扰下调PPP2R5C对T-ALL TCR Vβ亚家族分布和克隆增殖的影响

目的:基于前期利用靶向PPP2R5C基因的小干扰RNA(PPP2R5C-siRNA)抑制白血病T细胞增殖的结果,进一步了解PPP2R5C-siRNA对T-ALL样本中TCR Vβ亚家族基因谱系及其克隆性增殖情况.方法:利用PPP2R5C-siRNA转染2例初发未治疗T-ALL病人外周血单个核细胞(PBMC),设无关序列对照组(SC)和空白对照组(NC);利用实时定量PCR检测PPP2R5C基因表达水平.利用RT-PCR扩增各组样本中24个TCR Vβ亚家族基因的互补决定区3(CDR3);阳性产物进一步经基因扫描分析CDR3长度,了解其Vβ亚家族T细胞克隆性.结果:PPP2R5C-siRNA处理后明显下调PBMC中PPP2R5C基因表达水平.2例初发T-ALL外周血中分别可检测到10和17个Vβ亚家族,多数Vβ亚家族T细胞为多克隆性,病例1中Vβ9和Vβ17为寡克隆性,而病例2中,Vβ14和Vβ16呈寡克隆性;经过RNA干扰处理后,TCR Vβ亚家族表达率降低,仅检测到3和4个Vβ亚家族,分别为Vβ2,Vβ3,Vβ16和Vβ17.其中2个Vβ家族的寡克隆性模式发生改变,病例1中,Vβ17转为多克隆,而病例2中,Vβ16也转变为多克隆.结论:RNA干扰下调白血病T细胞PPP2R5C基因表达抑制细胞增殖时,在一定程度上影响TCR Vβ亚家族T细胞增殖和克隆模式变化,对正常T细胞功能可能存在一定影响.

儿童CD19 CAR-T细胞治疗相关B细胞再生障碍的临床意义和对策

急性B系淋巴细胞白血病(B-ALL)患儿在CD 19 CAR-T细胞治疗后普遍发生B细胞再生障碍(BCA),BCA持续的时间长短对患者的免疫状态及预后会产生影响。对BCA的充分认识有助于临床医师科学、规范、合理地选择治疗策略,减少CAR-T治疗后白血病患儿的感染机会,提高生活质量,改善预后。