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首页> 外文期刊>Nature clinical practice. Oncology >Experimental and clinical approaches for optimization of the graft-versus-leukemia effect.
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Experimental and clinical approaches for optimization of the graft-versus-leukemia effect.

机译:优化移植物抗白血病作用的实验和临床方法。

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The goal of allogeneic (allo)-hematopoietic stem-cell transplantation (HSCT) in the treatment of hematologic malignancies is to harness the graft-versus-leukemia (GVL) effect, while minimizing the risk of graft-versus-host disease (GVHD). Allo-HSCT research has focused on the GVL target antigens and effector mechanisms, and on potential approaches to exploit GVL independently of GVHD. Donor lymphocyte infusion (DLI) achieves the most powerful anti-leukemic responses, and this approach is often used in combination with nonmyeloablative transplant regimens to optimize GVL and reduce GVHD. Serial, dose-escalating, and CD8(+) T-cell-depleted DLI have been introduced into clinical practice, while other variants of DLI have so far been explored only in animal models. The role of naturally occurring regulatory T cells in transplantation tolerance is being increasingly acknowledged, and murine studies indicate the potential ability of T cells to regulate GVHD while maintaining GVL. Experimental and clinical studies have demonstrated the importance of host-type chimerism, particularly for antigen-presenting cells, in determining the occurrence of DLI-induced GVL. Murine studies could assist in the development of clinical strategies targeted at antigen-presenting cells. Clinical studies exploiting natural killer-cell-mediated antitumor reactivity in the context of killer inhibitory receptor-ligand-mismatched allo-HSCT have provided promising results.
机译:同种异体(造血)造血干细胞移植(HSCT)在血液系统恶性肿瘤治疗中的目标是利用移植物抗白血病(GVL)效应,同时将移植物抗宿主病(GVHD)的风险降至最低。 Allo-HSCT研究集中在GVL靶抗原和效应子机制上,以及与GVHD无关地开发GVL的潜在方法。供体淋巴细胞输注(DLI)实现了最强大的抗白血病反应,该方法通常与非清髓性移植方案结合使用以优化GVL并降低GVHD。串行,剂量递增和CD8(+)T细胞耗尽DLI已被引入临床实践,而到目前为止,仅在动物模型中探索了DLI的其他变体。天然存在的调节性T细胞在移植耐受中的作用已得到越来越多的认识,鼠类研究表明T细胞在维持GVL的同时调节GVHD的潜在能力。实验和临床研究表明,宿主型嵌合体(特别是对于抗原呈递细胞)在确定DLI诱导的GVL发生中的重要性。鼠类研究可以帮助开发针对抗原呈递细胞的临床策略。在杀手抑制性受体-配体错配的异源-HSCT的背景下利用自然杀伤细胞介导的抗肿瘤反应性的临床研究提供了可喜的结果。

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