美國(guó)弗吉尼亞聯(lián)邦大學(xué)梅賽癌癥中心(Virginia Commonwealth University Massey Cancer Cente)骨髓移植項(xiàng)目研究人員證實(shí)利用來(lái)自兔子的抗體能夠改善接受來(lái)自非親緣供者的干細(xì)胞移植的白血病和脊髓發(fā)育不良(myelodysplasia)患者的存活和疾病復(fù)發(fā)結(jié)果,。研究結(jié)果于近期發(fā)表在Bone Marrow Transplantation期刊上,。
論文通訊作者Amir Toor領(lǐng)導(dǎo)的一個(gè)研究小組總結(jié)性地比較了在接受兔抗胸腺細(xì)胞球蛋白(anti-thymocyte globulin, ATG)注射之后再接受來(lái)自非親緣供者干細(xì)胞移植的50名患者和接受來(lái)自親屬供者干細(xì)胞移植的40名患者,。盡管非親緣供者干細(xì)胞移植的治療效果通常要比親屬供者干細(xì)胞移植的要差,，但是這項(xiàng)研究的結(jié)果顯示就死亡率、疾病復(fù)發(fā)和產(chǎn)生移植物抗宿主病(graft-versus-host disease, GVHD)而言,，這兩組患者的治療效果較類似,。
與來(lái)自患者親屬供者的干細(xì)胞移植相比，非親緣供者干細(xì)胞移植通常因會(huì)引起較高比率的疾病復(fù)發(fā)和移植物抗宿主病而被認(rèn)為是一種風(fēng)險(xiǎn)較高的治療方法,。這項(xiàng)研究表明注入兔抗胸腺細(xì)胞球蛋白(ATG)能夠降低循環(huán)T淋巴細(xì)胞(circulating T-lymphocyte)的數(shù)量而發(fā)揮作用,，能夠顯著性地降低移植物抗宿主病產(chǎn)生和疾病復(fù)發(fā)。ATG也被用來(lái)治療再生障礙性貧血癥(aplastic anemia)---該疾病的特征在于骨髓不能產(chǎn)生足夠多的新細(xì)胞,。不過(guò),，研究人員注意到接受最高劑量ATG注射的患者遭受更高比率的感染，然而這種風(fēng)險(xiǎn)在接受稍低劑量ATG注射的患者身上大為減少,。
當(dāng)前有兩種類型的ATG試劑能夠用于臨床應(yīng)用：其中一種也就是這項(xiàng)研究中所用的兔抗體,，另一種是馬抗體。
由于人們不能總是找到需要干細(xì)胞移植的患者的親屬供者,，因此利用非親緣供者干細(xì)胞移植獲得較好的治療效果可能代表著人們?cè)谘娱L(zhǎng)更多血癌患者的生命方面取得一次巨大的進(jìn)步,。此外，這項(xiàng)研究也可能有助于人們?cè)O(shè)計(jì)未來(lái)的臨床試驗(yàn)以便利用ATG來(lái)改善非親緣供者干細(xì)胞移植的治療效果,。(生物谷：Bioon.com)
doi: :10.1038/bmt.2012.8
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PMID:
Anti-thymocyte globulin for conditioning in matched unrelated donor hematopoietic cell transplantation provides comparable outcomes to matched related donor recipients
DA Portier1, RT Sabo, CH Roberts, DS Fletcher, J Meier, WB Clark, MC Neale, MH Manjili, JM McCarty, HM Chung and AA Toor
Rabbit anti-thymocyte globulin (ATG) is used as prophylaxis against GVHD following allogeneic hematopoietic cell transplantation(HCT). At our institution, ATG is exclusively used in the conditioning of matched unrelated donor (URD) transplant recipients. A total of 50 URD HCT recipients who received ATG (ATG group) were retrospectively compared with 48 matched related donor (MRD) HCTrecipients who did not receive ATG (no ATG group). There were no significant differences between the groups in rates of day 100 mortality, acute GVHD or relapse. Chronic GVHD incidence was significantly lower in the ATG group (P ¼ 0.007). At a median followup of 36 months in the entire cohort, 50% patients are alive in the ATG group and 63% of the patients are alive in the no ATG group(P ¼ 0.13). We conclude that the administration of ATG to patients undergoing URD HCT preserves the anti-leukemia benefit of thetransplant, while reducing the risk of developing GVHD, resulting in OS rates that are comparable to MRD HCT recipients.
