Successful immune reconstitution decreases leukemic relapse and improves survival in recipients of unrelated cord blood transplantation

被引:121
作者
Parkman, Robertson
Cohen, Geoff
Carter, Shelly L.
Weinberg, Kenneth I.
Masinsin, Bernadette
Guinan, Eva
Kurtzberg, Joanne
Wagner, John E.
Kernan, Nancy A.
机构
[1] Childrens Hosp Los Angeles, Saban Res Inst, Div Res Immunol Bone Marrow Transplantat, Los Angeles, CA 90027 USA
[2] EMMES Corp, Rockville, MD USA
[3] Dana Farber Canc Inst, Boston, MA 02115 USA
[4] Duke Univ, Med Ctr, Durham, NC USA
[5] Univ Minnesota, Minneapolis, MN USA
[6] Mem Sloan Kettering Canc Ctr, New York, NY 10021 USA
关键词
immune reconstitution; tumor immunity;
D O I
10.1016/j.bbmt.2006.05.008
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Allogeneic hematopoietic stem cell transplantation (HSCT) is established therapy for selected patients with acute leukemia. After transplantation, antileukemic immune responses are believed to eliminate residual leukemia cells and decrease the likelihood of relapse. However, the clinical effect of successful antigen-specific immune reconstitution after HSCT on the likelihood of leukemic relapse and overall survival is not known. Pediatric recipients of unrelated cord blood transplants who underwent transplantation for acute leukemia were sequentially evaluated for their development of antigen-specific T-lymphocyte immunity to herpes viruses. The clinical effect of a positive antigen-specific response on relapse-free survival was determined. The presence of an antigen-specific response resulted in a relapse-free survival advantage (P = .0001), which was primarily due to a decrease in leukemic relapse (P = .003). Proportional hazards modeling for time to relapse and time to relapse or death defined 3 variables that were strongly associated with a poor outcome: female gender, poor remission status before transplantation, and negative antigen-specific T-lymphocyte proliferation. Notably neither acute nor chronic graft-versus-host disease had any effect on the incidence of leukemic relapse. Successful antigen-specific immune reconstitution after unrelated cord blood transplantation results in decreased leukemic relapse and improved overall survival. 2006 American Society for Blood and Marrow Transplantation.
引用
收藏
页码:919 / 927
页数:9
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