Dynamic observation of GVHD induced by chemotherapy and Th17/Treg in a relapse T-ALL patient after allo-HSCT / 白血病·淋巴瘤

ABSTRACT

Objective To explore clinical features of chemotherapy-induced graft-versus-host disease and to observe the dynamical changes of Th17/Treg ratio and related cytokines in one relapsed acute T-lymphoblastic leukemia after allo HSCT.Methods Twenty health volunteers were healthy controls.One patient achieved complete haematologic remission after two courses of chemotherapy and underwent matched HLA identical sibling allogenic peripheral blood stem cell transplantation,donor cell implanted state,disease recurrence and graft-versus-host disease were observed and Th17/Treg cells and its related factors in the peripheral blood were detected in different periods dynamically changes by methods of flow cytometry and ELISA.Results The patient achieved complete donor chimerism (FDC) at day +27 after transplantation.Hematopoietic function was fully recovered at day +34.Chronic GVHD (cGVHD) occurred at day +110.Thereafter,extramedullary relapse occurred in cGVHD state at day +264.After one course of Hyper-CVAD chemotherapy,patient complicated overlap syndrome with cGVHD of oral cavity ulcer and degree Ⅳ intestinal aGVHD at day +294 and day +347,respectively.Th17 cell ratio in CD+4 T cells (1.7 ％) in the overlap syndrome slightly increased,compared with control group [(0.56±0.35) ％].The ratio of Treg cells in CD+4 T cells (4.66 ％) with cGVHD increased compared with normal control group [(0.59±0.33) ％],recurrence (0.39 ％),and hematopoietic stem cell implantation (1.15 ％),but the ratio of Treg cells increased significantly when patient complicated overlap syndrome (7.83 ％).The ratios of Th17/Treg were more than 1 at relapse stage and less than 1 at GVHD stage.The IL-17A level in serum significantly increased in cGVHD (6.114 pg/ml)and overlap syndrome (6.805 pg/ml) stage compared with normal control group [(5.19±0.77) pg/ml].TGF-β1 levels were significantly higher at different periods after transplantation compared with control group [(48.81±4.9) ng/ml].Conclusion Chemotherapy can induce GVHD in relapsed acute leukemia patients after hematopoietic stem cell transplantation,and the imbalance of the Th17/Treg cells and its cytokines maybe related with disease relapse and GVHD.