Graft-versus-leukemia reactions after bone marrow transplantation.
Graft-versus-leukemia reactions after bone marrow transplantation.
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DOI：
10.1182/blood.v75.3.555.555
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发表时间：
1990-02
期刊：
影响因子：
20.3
通讯作者：
M. Horowitz;R. Gale;P. Sondel;J. Goldman;J. Kersey;H. Kolb;A. Rimm;O. Ringdén;C. Rozman
中科院分区：
文献类型：
--
作者：
M. Horowitz;R. Gale;P. Sondel;J. Goldman;J. Kersey;H. Kolb;A. Rimm;O. Ringdén;C. Rozman
为了确定移植物抗白血病（GVL）反应是否在预防骨髓移植后白血病复发中起重要作用，我们研究了2,254例接受HLA相合同胞骨髓移植的急性髓细胞性白血病（AML）首次缓解、急性淋巴细胞性白血病（ALL）首次缓解和慢性髓细胞性白血病（CML）首次慢性期患者。四组进行了详细的研究：非T细胞耗尽的同种异体移植物的受体没有移植物抗宿主病（GVHD），受体的非T细胞耗尽的同种异体移植物与GVHD，T细胞耗尽的同种异体移植物的受体，和受体的遗传相同的双胞胎移植。与未发生GVHD的非T细胞耗竭同种异体移植物的受者相比，急性（相对危险度0.68，P = .03）、慢性（相对危险度0.43，P = .01）以及急性和慢性GVHD（相对危险度0.33，P = .0001）的非T细胞耗竭同种异体移植物的受者复发率降低。这些数据支持GVHD的抗白血病作用。接受同卵双胞胎移植的AML患者与无GVHD的同种异体移植受者相比，复发概率增加（相对风险2.58，P = 0.008）。这些数据支持异基因移植物的抗白血病作用独立于GVHD。CML患者接受T细胞耗尽移植或不GVHD复发的可能性（相对风险分别为4.45和6.91，P = 0.0001）比非T细胞耗尽移植无GVHD。这些数据支持抗白血病作用独立于由T细胞耗竭改变的GVHD。这些结果解释了异基因骨髓移植在根除白血病方面的疗效，为免疫系统在控制人类癌症中的作用提供了证据，并提出了改善白血病治疗的未来方向。
To determine whether graft-versus-leukemia (GVL) reactions are important in preventing leukemia recurrence after bone marrow transplantation, we studied 2,254 persons receiving HLA-identical sibling bone marrow transplants for acute myelogenous leukemia (AML) in first remission, acute lymphoblastic leukemia (ALL) in first remission, and chronic myelogenous leukemia (CML) in first chronic phase. Four groups were investigated in detail: recipients of non--T-cell depleted allografts without graft-versus-host disease (GVHD), recipients of non--T-cell depleted allografts with GVHD, recipients of T-cell depleted allografts, and recipients of genetically identical twin transplants. Decreased relapse was observed in recipients of non--T-cell depleted allografts with acute (relative risk 0.68, P = .03), chronic (relative risk 0.43, P = .01), and both acute and chronic GVDH (relative risk 0.33, P = .0001) as compared with recipients of non--T-cell depleted allografts without GVHD. These data support an antileukemia effect of GVHD. AML patients who received identical twin transplants had an increased probability of relapse (relative risk 2.58, P = .008) compared with allograft recipients without GVHD. These data support an antileukemia effect of allogeneic grafts independent of GVHD. CML patients who received T-cell depleted transplants with or without GVHD had higher probabilities of relapse (relative risks 4.45 and 6.91, respectively, P = .0001) than recipients of non--T-cell depleted allografts without GVHD. These data support an antileukemia effect independent of GVHD that is altered by T-cell depletion. These results explain the efficacy of allogeneic bone marrow transplantation in eradicating leukemia, provide evidence for a role of the immune system in controlling human cancers, and suggest future directions to improve leukemia therapy.