Objective: To compare the early stage immune reconstitution of high- and standard-risk Philadelphia chromosome- negative acute lymphoblastic leukemia (ALL) CR1 patients who had haploidentical blood and marrow stem cell transplantation (HBMT).
Methods: A total of 49 Ph-negative ALL CR1 patients who received HBMT and had complete early stage immune reconstitution data(+30, +60 and +90 d post transplantation) from Jan. 2010 to Dec. 2012 were enrolled. Immunophenotyping for B and T lymphocytes was performed post HBMT via flow cytometry. Fresh peripheral blood cells were stained with fluorochrome-labeled monoclonal antibodies against cluster of differentiation CD19, CD3, CD4, CD8, CD45RO, CD45RA and CD28. The early reconstitution of lymphocyte subsets, survival and prognosis between standard- risk group, high- risk adult group and high- risk children group were compared.
Results: There were no significant differences in all these T lymphocyte subsets among three groups at the three check points (P>0.05). Moreover, at the same time, comparable outcome had been achieved between standard-risk group (n=18), high-risk adult group (n=16) and high-risk children group (n=15). There were no differences in 2- y relapse incidence (27.8% vs 31.3% vs 26.7%, P=0.957), 2- y non- relapse mortality (11.1% vs 0 vs 13.3%, P=0.185), 2- y leukemia free survival (61.1% vs 68.8% vs 60.0%, P=0.834) and overall survival (77.8% vs 68.8% vs 60.0%, P=0.529) among the three groups. Incidence of grade Ⅱ-Ⅳ aGVHD was 44.4% vs 12.5% vs 46.7% (P=0.075) and incidence of cGVHD was 61.1% vs 50.0% vs 40.0% (P=0.249).
Conclusion: Comparison of immune reconstitution at early stage may be a reasonable cause to explain that equivalent outcomes were observed among high- and standard- risk Ph- negative ALL CR1 patients after HBMT.
目的: 比较费城染色体（Ph）阴性急性淋巴细胞白血病（ALL）第1次完全缓解期（CR1）高危组与标危组患者非体外去T细胞单倍型骨髓联合外周血造血干细胞移植（haploidentical blood and marrow stem cell transplatation, HBMT）术后早期免疫重建与预后特征。
方法: 以2010年1月至2012年12月在北京大学人民医院行HBMT的49例Ph阴性ALL CR1患者为研究对象，应用流式细胞术分别检测患者＋30 d、+60 d及＋90 d外周血CD19+、CD3+、CD4+、CD8+、CD4+CD45RO+、CD4+CD45RA+、CD4+CD28+及CD8+CD28+淋巴细胞亚群免疫重建指标，比较标危组（18例）、成人高危组（16例）及儿童高危组（15例）淋巴细胞亚群早期重建规律、生存状况及预后。
结果: 三组患者CD3+、CD4+CD28+、CD8+CD28+、CD4+CD45RO+和CD4+CD45RA+等早期免疫重建（+30 d、+60 d及＋90 d）指标差异均无统计学意义。标危组、成人高危组及儿童高危组患者2年复发率（27.8%、31.3%、26.7%，P=0.957）、2年非复发死亡率（11.1%、0、13.3%，P=0.185）、2年无白血病生存率（61.1%、68.8%、60.0%，P=0.834）及总生存率（77.8%、68.8%、60.0%，P=0.529）差异均无统计学意义。三组患者移植后100 d内Ⅱ~Ⅳ度急性移植物抗宿主病发生率（44.4%、12.5%、46.7%，P=0.075）和2年总慢性移植物抗宿主病发生率（61.1%、50.0%、40.0%，P=0.249）差异无统计学意义。
结论: 在HBMT模式下，Ph阴性ALL CR1高危组与标危组患者移植后可取得相当的早期免疫重建，这可能是克服移植前高危因素并取得相同移植疗效的免疫机制之一。