【摘要】 目的研究血清抗HLA抗体与异基因造血干细胞移植(allo-HSCT)后移植物被排斥、疾病复发及移植物抗宿主病(GVHD)的关系。方法20例allo-HSCT患者在移植前与移植后1、3、6个月动态检测抗HLA抗体。结果移植前抗HLA抗体≥30%与<30%的患者发生原发植入失败比较无显著性差异(P>0.05);在成功植入的17例患者中,移植前和(或)移植后抗HLA抗体≥30%的5例患者均发生移植物被排斥或疾病复发,而抗HLA抗体均<30%的12例患者中仅有1例发生,两者有显著性差异(P<0.005)。移植后抗HLA抗体呈动态升高的3例患者均在植入后且抗HLA抗体≥30%时发生移植物被排斥和疾病复发,而呈动态降低的5例患者仅有1例在植入后发生移植物被排斥。移植前和(或)移植后抗HLA抗体≥30%的5例患者均未发生GVHD;而抗HLA抗体<30%的12例患者中有9例发生急性和(或)慢性GVHD,发生率75%,两者有显著性差异(P<0.005)。结论对allo-HSCT受者在移植前、后动态检测抗HLA抗体有助于预测移植物被排斥、疾病复发与GVHD的发生,抗HLA抗体≥30%或呈动态升高者继发植入失败或疾病复发的发生率高,而GVHD发生率较低。更多还原

【Abstract】 Objective To investigate the effect of antiHLA antibodies on graft failure,disease relapse and graft versus host disease(GVHD) before and after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods Sera from 20 allo-HSCT recipients were prospectively analyzed.Pre-transplant and 1,3,6 months post-transplant sera were tested for anti-HLA antibodies.All recipients were monitored for routine clinical data including analysis of chimerism and minimal residue diseases.Results 6 pre-and/or post-transplant anti-HLA antibodies≥30% recipients had a primary graft failure rate of 16.67%(n=1),compared with 16.26%(n=2) among 14 anti-HLA antibodies<30% subjects(P>0.05).Among 17 engrafted recipients,all of the 5 pre-and/or post-transplant anti-HLA antibodies≥30% recipients had secondary graft failure or relapse,compared with only 1 of 12 anti-HLA antibodies<30% recipients(P<0.005).3 recipients with increasing anti-HLA antibodies all had secondary graft failure when anti-HLA antibodies ≥30%,compared with only 1 of 5 subjects with decreasing anti-HLA antibodies.Among 17 engrafted recipients,none of 5 pre-and/or post-transplant anti-HLA antibodies≥30% patients had GVHD,compared with 9(75%) among 12 anti-HLA antibodies<30% subjects(P<0.005).Conclusions The study suggested that the anti-HLA antibodies in pretransplant and early posttransplant period of allo-HSCT recipients correlate with secondary graft failure,disease relapse and GVHD.Recipients with preand/or post-transplant anti-HLA antibodies≥30% or increasing anti-HLA antibodies had higher incidence of secondary graft failure and disease relapse,while lower incidence of GVHD.更多还原