Outcomes of Immunological Interventions for Mixed Chimerism Following Allogeneic Stem Cell Transplantation in Children With Juvenile Myelomonocytic Leukemia
Outcomes of Immunological Interventions for Mixed Chimerism Following Allogeneic Stem Cell Transplantation in Children With Juvenile Myelomonocytic Leukemia
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DOI：
10.1002/pbc.24259
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发表时间：
2013-01-01
影响因子：
3.2
通讯作者：
Okamura, Jun
中科院分区：
文献类型：
--
作者：
Inagaki, Jiro;Fukano, Reiji;Okamura, Jun
背景。对于接受干细胞移植（SCT）的幼年型粒单核细胞白血病（JMML）儿童，免疫干预措施（包括停止免疫抑制治疗（IST）和供体淋巴细胞输注（DLI））在治疗疾病复发中的作用仍不确定。程序。我们分析了 SCT 后的连续嵌合状态，并评估了免疫干预治疗 JMML 儿童混合嵌合 (MC) 的效果。结果。在第一次和第二次 SCT 后的 26 例 SCT 病例中进行了嵌合分析。 16例观察到MC，14例发现MC后立即撤药。对 5 例 MC 病例进行了供体淋巴细胞输注 (DLI)。中性粒细胞恢复时观察到 8 例 MC 病例。撤回 IST 后，3 例实现完全嵌合（CC），而其余 5 例中自体细胞的比例迅速增加。在达到血液学缓解（HR）后观察了 6 例 MC 病例，并在 2 例中观察到了对 IST 撤药的反应。在其余 4 例中，尽管取消了 IST，自体细胞的比例仍然增加。 5 例接受了 DLI，但只有 1 例做出了回应。结论。尽管 JMML SCT 后免疫干预对 MC 的益处有限，但一些患者由于这些治疗方式而无需进行第二次 SCT，确实实现了 HR。密切监测供体嵌合状态和早期检测 MC 有助于指导 JMML 儿童 SCT 后的治疗。儿科血癌2013； 60：116-120。 (C) 2012 年 Wiley 期刊公司。
Background. For children with juvenile myelomonocytic leukemia (JMML) who undergo stem cell transplantation (SCT), the role of immunological interventions including withdrawal of immunosuppressive therapy (IST) and donor lymphocyte infusion (DLI) for treatment of disease recurrence remains uncertain. Procedure. We analyzed serial chimerism status following SCT and evaluated the efficacy of immunological interventions for the management of mixed chimerism (MC) in children with JMML. Results. Chimerism analysis was available in 26 SCT cases following the first and second SCT. MC was observed in 16 cases and withdrawal of IST was performed in 14 cases immediately after identification of MC. Donor lymphocyte infusion (DLI) was performed in five MC cases. Eight MC cases were observed at the time of neutrophil recovery. Following withdrawal of IST, three cases achieved complete chimerism (CC) while the proportion of autologous cells increased rapidly in the remaining five cases. Six MC cases were observed after achievement of hematological remission (HR) and responses to withdrawal of IST were observed in two cases. In the remaining four cases, despite withdrawal of IST, the proportion of autologous cells increased. Five cases received DLI but only one case responded. Conclusion. Although the benefits of immunological interventions for MC after SCT in JMML were limited, some patients did achieve HR as a result of these treatment modalities without a second SCT. Close monitoring of donor chimerism and early detection of MC is helpful in guiding treatment after SCT in children with JMML. Pediatr Blood Cancer 2013; 60: 116-120. (C) 2012 Wiley Periodicals, Inc.