| Objective:To evaluate the prediction value of IL-21,IL-23 and CCR5 in acute graft versus host disease(aGVHD),serum IL-21,IL-23 and CCR5 levels was monitored in different period of allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:1 Research time: November 2014 to November 2015.2 Research site: Hematologic Department of the Second Hospital of Hebei medical university medical.3 Research object: 17 patients undergoing allo-HSCT.4 Clinical features of patients:(1)10 male,7 femal.(2)Acute myeloid leukemia(AML)in 5 cases,at the first complete remission(CR1).3 cases of acute lymphoblastic leukemia(ALL),CR1 in 2 cases,the second complete remission(CR2)in 1 case.Acute mixed cells leukemia in 1 case of CR2.Myelodysplastic Syndrome(MDS),3 cases of Refractory cytopenia with more primitive cells subtypes(MDS RAEB),IPSS: 3 cases of high risk group.Type I Severe aplastic anemia(SAA)account for 3 cases,and atypical Chronic Myelogenous Leukemia in 1 case,1 case of Lymphoma IV.(3)2 cases of Unrelated donor HLA10/10 matched transplantation,Sibling HLA10/10 matched transplantation in 5 cases,Relative donor HLA 5/10-9/10 Itransplantation(haplo-HSCT)for 10 cases.(4)MUD-PBST,MSD-PBST,PB+BM)ST-MSD,Haplo-HSCT(PB+BM)account for 2,1,4,10 cases respectvely.5 The normal control group: 13 hematopoietic stem cell health donors.6 Sample collection: We collect 4ml peripheral blood from recipients with a pro-coagulant tube.7 Collection time: The aGVHD-positive group:-7d,01 d,+7d,the occurrence of aGVHD and 5d,10 d after that.The aGVHD-negative groups:-7d,01 d,+7d,+14d,+21d,+28d.The normal control group:before and after G-CSF mobilization.8 Detection way: We use Enzyme-linked immunosorbent assay(ELISA)of American RD company to detect serum IL-21,IL-23 and CCR5 levels at different times.9 Statistics:Comparison of paired data and multiple measurement data among groups,we apply paired t-test and one-way analysis of variance,respectively.If P<0.05,we consider the data has statistical significance.Results:1 Engrafment of donor stem cell for 16 patients achieved success.Neutrophil was engrafmented at 11-14 days with median time of 11 days.Platelet was engrafmented at 11-25 days with medium time of 14 days.One case,neutrophil was engrafmented at +12 days,but died of severe aGVHD;2 10 of the 17(58%)patients developed aGVHD,including 3 cases of IV aGVHD and 7 cases of II-III aGVHD.The incidence of aGVHD in the patients was 58%;3 Transplant outcome: 3 of 5 cases died of IV aGVHD,1 died of relapse and 1 died of other transplantation-related complication;4 Serum IL-21,IL-23 and CCR5 levels among each group:4.1 The normal control group: Serum IL-21,IL-23 and CCR5 levels were no significant before and after mobilization(P=0.484,0.358,0.262,respectively).4.2 The aGVHD-negative group: There were no difference in IL-21,IL-23 and CCR5 levels of-7d,1d,+7d,+14d,+21d,+28d(P=0.997,P=0.951,P=0.988).4.3 The aGVHD-positive group:4.3.1 Compared to those of-7 day,01 day,+7 day,serum IL-21,IL-23 and CCR5 levels when aGVHD happened significantly increased,which then markedly decreased at 5d and 10 d after aGVHD,differences were statistically significant(P<0.05 for all).4.4 Comparison of IL-21,Il-23 and CCR5 levels among groups:Serum IL-21,IL-23 and CCR5 levels of the aGVHD-positive group significantly increased when compared to those of the normal control group(P<0.001,for all)and the aGVHD-negative group(P<0.001,P=0.04,P<0.001,respectively).Serum IL-21,IL-23 and CCR5 levels of the aGVHD-negative group also significantly increased when compared to those of the normal control group(P<0.01,for all);5 Comparison of IL-21,IL-23 and CCR5 levels in different prognosis of aGVHD:Compared to the cure group,there were significant differences in serum IL-21,IL-23 and CCR5 levels of the aGVHD-related death group(P=0.03,P=0.007,P=0.012);6 Comparison of IL-21,IL-23 and CCR5 levels in different grades of aGVHD:Serum IL-21,IL-23 and CCR5 levels of the severe a GVHD group significantly increased when compared to those of the mild aGVHD group(P=0.03,P=0.018,P=0.04).Conclusion:1 Serum IL-21,IL-23 and CCR5 levels of transplant donor were not affected by mobilization(G-CSF).2 Serum IL-21,IL-23 and CCR5 levels of transplant recipient were increased by preconditioning.3 Serum IL-21,IL-23 and CCR5 levels showed significantly higher upon occurrence of aGVHD.Serum IL-21,IL-23 and CCR5 levels of the severe recipients significantly increased when compared to those of the mild recipients.4 After effective treatment,Serum IL-21,IL-23 and CCR5 levels of aGVHD-positive patients decreased.However,Serum IL-21,IL-23 and CCR5 levels of the aGVHD-related death patients still increased. |
