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中文摘要：
目的 探讨异基因造血干细胞移植（allo-HSCT）后白血病复发伴活动性移植物抗宿主病（GVHD）患者GVHD与GVL效应的分离.方法 分析11例接受allo-HSCT后在白血病复发时存在活动性GVHD的患者其原发病、疾病状态、复发时GVHD类型、供者淋巴细胞输注（DLI）疗效及转归等对GVL效应的影响.结果 11例患者包括急性淋巴细胞白血病5例,急性髓系白血病6例,其中5例曾行预防性DLI,复发时伴有活动性DLI后GVHD,包括2例Ⅱ度急性GVHD（aGVHD）,1例原局限型慢性GVHD（cGVHD）加重＋新发Ⅱ度aGVHD,2例广泛型cGVHD 这5例患者复发后,2例行化疗＋治疗性DLI,DLI后在广泛型cGVHD反复加重情况下,1例达完全缓解（CR）后再次复发,1例未达CR.另6例患者复发前未行预防性DLI,白血病复发时亦均存在活动性GVHD,包括3例广泛型cGVHD、1例Ⅰ度aGVHD及2例Ⅲ～Ⅳ度aGVHD,复发后行化疗＋治疗性DLI,之后2例达CR后再次复发,4例未达CR.结论 allo-HSCT后活动性GVHD不一定伴随可抑制白血病复发的有效GVL效应.
英文摘要：
Objective To explore the dissociation of graft-versus-leukemia （GVL） effects from graftversus-host disease （GVHD） in the patients who experienced GVHD during leukemia relapse after allogeneic hematopoietic stem cell transplantation （allo-HSCT）. Methods The primary disease, disease status,GVHD, response to donor lymphocyte infusion （DLI） and prognosis were analysed in 11 leukemia patients who relapsed with GVHD after allo-HSCT. Results Of the 11 relapsed, 5 were acute lymphoblastic leukemia and 6 acute myeloid leukemia. Five received DLI before relapse and all developed post-DLI GVHD, including 2 grade Ⅱ acute GVHD （aGVHD）, 1 limited chronic GVHD（cGVHD） plus grade Ⅱ aGVHD, and 2 extensive cGVHD. After relapse of the 5 patients, 2 received Chemo-DLI, one achieved CR with extensive cGVHD and then relapsed again, the other didn＇t achieved CR. The other 6 patients didn＇t received DLI before relapse and also developed post-HSCT GVHD while relapsing, including 3 extensive cGVHD, 1 grade ⅠaGVHD and 2 grade Ⅱ - Ⅳ aGVHD. After relapse, these 6 patients received Chemo-DLI, 2 achieved CR and then relapsed again, 4 didn＇t achieved CR. Conclusion The elicited GVHD after allo-HSCT may not accompany effective GVL effects inhibiting leukemic relapse.
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