摘要
目的:探索巨细胞病毒(CMV)的DNA负荷对非血缘脐血移植(UCBT)后免疫重建和临床结局的影响。方法:8色流式细胞术动态监测41例患者UCBT后1年的外周血淋巴细胞亚群变化,同时纳入10例健康体检者作为正常人对照。根据CMV的DNA负荷水平(DNA拷贝<1 000/ml和DNA拷贝≥1 000/ml)将患者分为2组,比较分析移植后CMV的DNA负荷对淋巴细胞亚群重建及移植结局的影响。结果:CMV的DNA高负荷组呈现较快的T细胞重建,且移植后1年内的T细胞数均高于DNA低负荷组,2组间T细胞数在移植后1和9个月分别为0.38×10^9/L vs 0.25×10^9/L(P=0.015)和2.53×10^9/L vs 1.36×10^9/L(P=0.006)。进一步分析T细胞亚群提示,CD8^+T细胞在DNA高负荷组细胞数较高且恢复较快,2组间CD8^+细胞数在移植后1和9个月分别为0.20×10^9/L vs 0.10×10^9/L(P=0.038)和1.62×10^9/L vs 0.68×10^9/L(P=0.003)。另外,2组的B细胞、调节性B细胞和NK细胞数差异均无统计学意义。一年半的移植结局提示,DNA高负荷组和DNA低负荷组的复发率、非复发死亡率和总生存差异无统计学意义,分别为7.7%vs 7.5%(P=0.900)、15.4%vs 21.4%(P=0.686)和76.9%vs78.6%(P=0.889)。结论:UCBT后CMV的DNA高负荷促进T细胞的扩增,主要表现为CD8^+T细胞的扩增。在目前的CMV的抢先治疗下,UCBT后CMV的高DNA负荷不影响急性髓系白血病患者早期生存。
Objective:To investigate the effects of cytomegalovirus(CMV)DNA load on immune reconstitution and clinical outcomes of patients after unrelated cord blood transplantation(UCBT).Methods:Eight-color flow cytometry was used to dynamically monitor the changes of peripheral blood lymphocyte subsets of 41 patients at one year after UCBT,and 10 healthy volunteers were enroled as controls.Patients were divided into two groups according to the DNA load of CMV(DNA copies<1000/ml and DNA copies≥1000/ml).Comparative analyse of the effect of CMV DNA load on lymphocyte subsets and transplantation outcomes were carried out after transplantation.Results:The high CMV DNA load group showed a faster and expanded T cell reconstitution,and the differences between the two groups were statistically significant at one and nine months after transplantation(0.38×10^9/L vs 0.25×10^9/L,P=0.015 and 2.53×10^9/L vs 1.36×10^9/L,P=0.006,respectively).Further analysis of T cell subsets suggested that CD8^+T cells presented a higher and faster recovery in the high DNA load group,and the differences between the two groups were statistically significant at one and nine months after transplantation(0.20×10^9/L vs 0.10×10^9/L,P=0.038 and 1.62×10^9/L vs 0.68×10^9/L,P=0.003,respectively).In addition,there were no significant differences in levels of B cells,regulatory B cells and NK cells between the two groups.Outcomes after one-and a-half-year transplantation showed that there were no significant difference in relapse,non-relapse mortality and overall survival between the high and the low DNA load groups(7.7%vs 7.5%)(P=0.900)(15.4%vs 21.4%)(P=0.686)and(76.9%vs 78.6%)(P=0.889)respectively.Conclusion:The high CMV DNA load induces a faster and long-lasting expansion of T cells,mainly as the expansion of CD8^+T cells after UCBT.Besides,under the current pre-emptive treatment of CMV,the high CMV DNA load does not affect the early survival of patients with acute myeloid leukemia after UCBT.
作者
董漫玉
汤宝林
朱小玉
刘会兰
孙自敏
DONG Man-Yu;TANG Bao-Lin;ZHU Xiao-Yu;LIU Hui-Lan;SUN Zi-Min(Department of Hematology,The Affiliated Provincial Hospital of Anhui Medical University,Hefei 230001,Anhui Province,China;Department of Hematology,The Fist Affiliated Hospital of University of Science and Technology of China,Hefei 230001,Anhui Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2019年第5期1633-1640,共8页
Journal of Experimental Hematology
关键词
脐血移植
免疫重建
巨细胞病毒
DNA负荷
umbilical cord blood transplantation
immune reconstruction
cytomegalovirus
DNA load
