异基因造血干细胞移植(allogeneic hematopoietic stem cell transplantation,allo-HSCT)已成为治愈多种良、恶性血液系统疾病的唯一方法,许多病人获得了长期缓解。然而移植物抗宿主病(graft versus host disease,GVHD)大大阻碍了其发展和临床应用。目前认为,供者T细胞攻击宿主抗原引发的免疫反应是GVHD发病的重要机制,但供者T细胞在抗肿瘤、降低疾病复发率等方面又有不可替代的作用。因此,如何在抑制GVHD的同时保留移植物抗肿瘤(graft versus tumor,GVT)效应成为HSCT后的一大难题。近年来,丙戊酸、棘霉素等药物,联合使用CD4+与CD8+诱导调节性T细胞以及毫超微包囊T细胞等新型技术,在分离GVHD和GVT效应方面均取得了良好的实验效果,在临床治疗上具有巨大的潜力。
We aimed to access if acute graft-versus-host disease （aGVHD） in liver transplantation recipients of hepatocellular carcinoma （HCC） might develop a graft-versus-tumor effect （GVT） other than immunological damage which would benefit prophylaxis of tumor recurrence. Methods： Dynamic observation of 3 cases of liver transplantation recipients of HCC and cirrhosis, which developed manifestations of fever, skin rash, watery diarrhea, pancytopenia and were finally diagnosed as aGVHD. Two of which got recovered from intravenously pulse methylprednisolone, high-dose intravenous immunoglobulin, antibiotics administration simultaneously and promptly withdrawal of oral immunosuppressants. Two survivors were follow-up regularly with biological monitoring and imaging surveillance for tumor recurrence thereafter. Results： Two recipients survived healthily with stable liver graft function and normal serum AFP level and blood routine test. No sign of tumor recurrence was found in repeat imaging examinations for liver graft, lung, brain and other tissue or organs within a period of 96 months and 17 months to date, respectively. Conclusien： Despite of the fatal damage to according organs and tissue, it suggest that aGVHD in liver recipients of HCC may also develop a GVT effect and benefit prophylaxis of tumor recurrence and result in a long-term healthy recipients survival.
Sen XieLigong TangXiong CaiZhixiong LiHuanhuan ChenHui Bao
