Chinese Journal of Tissue Engineering Research ›› 2022, Vol. 26 ›› Issue (13): 1993-1999.doi: 10.12307/2022.323
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Xu Anhui, Lin Xiuxiu, Zhang Xuhan, Song Kaidi, Sun Guangyu, Tang Baolin, Sun Zimin, Zheng Changcheng
Received:
2021-01-13
Revised:
2021-01-16
Accepted:
2021-03-06
Online:
2022-05-08
Published:
2021-12-18
Contact:
Zheng Changcheng, MD, Professor, Chief physician, Doctoral supervisor, Department of Hematology, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Sun Zimin, Professor, Chief physician, Doctoral supervisor, Department of Hematology, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
About author:
Xu Anhui, Master candidate, Department of Hematology, First Affiliated Hospital of University of Science and Technology of China, Hefei 230001, Anhui Province, China
Supported by:
CLC Number:
Xu Anhui, Lin Xiuxiu, Zhang Xuhan, Song Kaidi, Sun Guangyu, Tang Baolin, Sun Zimin, Zheng Changcheng. Mechanism of separation of graft-versus-host disease and graft versus leukemia in unrelated cord blood transplantation for hematological malignancies[J]. Chinese Journal of Tissue Engineering Research, 2022, 26(13): 1993-1999.
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2.1 非血缘脐血移植具有明显的慢性移植物抗宿主病与移植物抗白血病效应分离现象 自2012-07-01/2017-06-31,共有154例成人血液肿瘤患者(年龄≥18岁)接受了造血干细胞移植治疗,其中非血缘脐血移植93例,同胞外周血干细胞移植61例。经过中位61个月(42-99个月)的长期随访,非血缘脐血移植组5年慢性移植物抗宿主病发生率为15.6%(95%CI:7.0-23.4),明显低于同胞外周血干细胞移植组37.6%(95%CI:22.4-49.9)(P=0.003),见图1A;非血缘脐血移植组5年广泛型慢性移植物抗宿主病发生率为7.6%(95%CI:1.5-13.3),明显低于同胞外周血干细胞移植组33.9%(95%CI:19.2-46.0)(P < 0.001)。非血缘脐血移植组5年移植后疾病复发率为7.5%(95%CI:3.3-14.1),明显低于同胞外周血干细胞移植组18.0%(95%CI:9.6-38.7)(P=0.046),见图1B。非血缘脐血移植组5年总生存率为71%(95%CI:60.6-79.1),同胞外周血干细胞移植组为63.9%(95%CI:50.6-74.6)(P=0.37);非血缘脐血移植组5年无病生存率为69.9%(95%CI:59.5-78.1),同胞外周血干细胞移植组为60.7%(95%CI:47.3-71.6)(P=0.28)。整合Ⅲ-Ⅳ度移植物抗宿主病、广泛性慢性移植物抗宿主病以及疾病复发、5年无复发生存(无移植物抗宿主病无疾病复发生存),非血缘脐血移植组为62.4% (95%CI:51.7-71.3),明显高于同胞外周血干细胞移植组42.6%(95%CI:30.1-54.5)(P=0.038),见图1C。 "
2.2 非血缘脐血移植患者T细胞及其亚群的分化 临床资料提示脐血移植具有较强的移植物抗白血病效应,为了进一步探讨脐血移植后T细胞及其亚群在移植物抗白血病效应中的作用,该研究收集脐血移植后1年内患者的骨髓血标本(n=14),采用流式细胞术进一步分析脐血移植后免疫细胞分化情况,见图2A。分析比较非血缘脐血移植患者和健康供者的CD3+/CD4+/CD8+T细胞占CD45+细胞的比例,发现非血缘脐血移植患者的CD45+CD3+T细胞比例与正常对照组相似(65.92% vs. 67.79%,P=0.86),见图2B,CD45+CD4+T细胞比例与正常对照组无明显差异(25.87% vs. 33.62%,P=0.28),见图2C,而CD45+CD8+T细胞的比例高于正常对照组(43.97% vs. 29.77%,P=0.05),见图2D。非血缘脐血移植患者CD45+CD4+T细胞群的比例(25.87%)明显低于CD45+CD8+T细胞群(43.97%)(P=0.004),见图2E,而健康供者CD45+CD4+T细胞群比例(33.62%)与CD45+CD8+T细胞群(29.77%)相似(P=0.37),见图2F。"
2.3 非血缘脐血移植和外周血干细胞移植后免疫细胞群的比较 检测了10例非血缘脐血移植和10例同胞异基因外周血干细胞移植患者的免疫细胞亚群分化情况,见图3。非血缘脐血移植组CD3+T细胞为81.03%,明显高于外周血干细胞移植组67.97%,差异有显著性意义(P=0.04),见图3A。移植后CD3+CD4+T细胞亚群比例:非血缘脐血移植组为21.33%,低于外周血干细胞移植组28.28%,见图3B;移植后CD3+CD8+细胞亚群比例:非血缘脐血移植组为65.60%,高于外周血干细胞移植组61.70%,见图3C;移植后CD4+/CD8+两个细胞亚群之比:非血缘脐血移植组为0.36,低于外周血干细胞移植组0.54,见图3D。尽管统计学差异不明显(可能与检测病例数较少有关),但是在非血缘脐血移植组以CD8+T细胞占主导趋势。 移植后CD19+B细胞比例,在非血缘脐血移植组为2.02%,外周血干细胞移植组为3.76%(P=0.51),见图3E。移植后CD56+NK细胞比例,在非血缘脐血移植组为12.86%,稍低于外周血干细胞移植组22.79%(P=0.11),见图3F;移植后Treg细胞亚群比例,在非血缘脐血移植组为5.29%,外周血干细胞移植组为4.45%(P=0.71),见图3G;移植后Breg细胞亚群比例,在非血缘脐血移植组为2.61%,稍低于外周血干细胞移植组10.16%(P=0.23),见图3H。 "
2.4 非血缘脐血移植和外周血干细胞移植后T细胞PD-1和CD80表达水平变化 CD80和PD-1是T细胞表面的两种重要的激活信号和抑制信号分子,继续进一步检测移植后CD4+T细胞和CD8+T细胞亚群的CD80和PD-1分子表达,见图4A。非血缘脐血移植组CD4+CD80+T细胞为17.08%,低于外周血干细胞移植组41.36%(P=0.089),见图4B,且非血缘脐血移植组CD4+PD-1+T细胞为25.76%,高于外周血干细胞移植组13.03%,见图4C,非血缘脐血移植组CD8+PD-1+T细胞为22.28%,高于外周血干细胞移植组9.01%(P=0.35),见图4D;非血缘脐血移植组CD8+CD80+T细胞为1.90%,高于外周血干细胞移植组0.05%,见图4E。与健康对照组相比,非血缘脐血移植后CD4+T细胞和CD8+T细胞表达PD-1和CD80的水平差异均显著性意义。"
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