Preliminary Explore The Clinical Significance Of Chemotherapy Combined With Autologous Cytokine-Induced Killer Cells Sequential Therapy In Elderly Patients With Acute Myeloid Leukemia

Background Acute Myeloid Leukemia is a kind of malignant clone hyperplastic disease which originated from the hematopoietic stem cell.When the disease happened,abnormal bone marrow of the primitive cells and immature cells proliferation and inhibition of normal hematopoietic cells decreased in great quantities,anemia,hemorrhage,infection are appeared,and liver,spleen,lymph node enlarged and other clinical manifestations.Acute Myeloid Leukemiais the most common type of leukemia in adults,the world with its average annual incidence of 22.5 per million,as the growth of the age the proportion of elderly patients are rising.Chemotherapy is the most important treatment to induce relieve for the acute myeloid leukemia patients,even chemotherapy regimens of individualized adjustments in recent years,the clinical curative effect in the elderly patients have no obvious improvement.Main reasons are elderly patients always with foundation physical disease,viscera function not beautiful,Individuals generally pool,low intolerance for high strength chemotherapy and all kinds of side reactions are concerned,at the same time there are serious infections,thrombosis and hemorrhage risk will affect survival.Thus ensure the well response rate and time,reduce the complications in the treatment process,prolong survival and improve quality of life are the key for the elderly patients with AML after chemotherapy.In recent years,along with the advance of immunology,cellular immune therapy become the most prospect method in application of hematological malignancy.Cytokine-induced killer cells is put forward for the first time in 1991 by Stanford university Schmidt-Wolf as an important part in adoptive cellular immunotherapy.Cytokine-induced killer cells are obtained by sequential in vitro stimulation of peripheral blood mononuclear cells with IFN-? and anti-CD3 monoclonal antibody,followed by regular addition of recombination human IL-2,thus representing a cell population have both biological characteristics of T and NK phenotype.CIK cells to kill tumor cells can be combined with target cells to kill tumor directly,but also can secrete a variety of cytokines and activation of apoptosis induced by Fas pathway and so on.Therefore,CIK cells to kill tumor powerful,and there is no obvious inhibitory effect on normal bone marrow hematopoietic stem cells.Long-term clinical studies have shown that CIK cells in the blood malignant tumor treatment shows good curative effect on the aspects of eliminate tiny residual,maintain remission,improve life quality and prolong the lifetime.So we bring the elderly patients with AML who cannot toleratechemotherapy into the study as the research object,adopt chemotherapy combined with CIK cells treatment,then preliminary explore and evaluate the clinical effectiveness and value.Objective Topreliminary observe and evaluate the clinical effectiveness of chemotherapy combined with autologous cytokine-induced killer(CIK)cells sequential therapy in elderly patients with acute myeloid leukemia(AML),then build a new maintenance therapeutic method with less side effect for AML.Methods Five elderly patients with AML were as the research object,who achieved complete remission or partial remission have a variety of complications and weak tolerance to continue chemotherapy.Observe and analyze the five patients' general symptoms and adverse reaction,cellular immune function,peripheral blood micro resist disease(MRD)lever,living quality and survival of five patients after CIK cells infusion.Results The resultsshowed no adverse reaction like fever or anaphylaxis appeared in the 35 cycles treatment of CIK cells infusion for 5 patients.After the infusion 5 patients' spirit,appetite,physical strength was improved.Detected the lever of immune cells in the body before CIK infusion and one week after infusion,result shows that one week after CIK infusion the proportion of effector cells CD3+ and CD3+CD8+ and CD3+CD56+ cells are increased before CIK infusion.One month after CIK infusion the effector cells also keep in a high lever compared with before infusion,the proportion of CD3+ cells 73.3 + 2.56 compared with 68.6 + 2.9 before infusion(P<0.05);the proportion of CD3+CD8+ cells 33.8±7.7 compared with 22.1±5.6 before infusion(P<0.05);the proportion of CD3+CD56+ cells 7.74±4.6 compared with 5.17±2.9 before infusion(P<0.05);after CIK infusion the percentage of regulate T cells and effect T cells 2.70±1.59 was reduced compared with 5.35±5.50 before the CIK infusion(P<0.05).Detected the MRD lever in peripheral blood before CIK infusion and two weeks after infusion,result shows that after the CIK infusion the level of MRD(0.16±0.30)% was significantly reduced compared with(0.86±0.84)% before the CIK infusion(P<0.05).Evaluated the patients physical state according to KPS score before and after CIK infusion,result shows that after the CIK infusion the score of KPS 88.8±6.03 was ameliorate than 75.45±10.35 before the CIK infusion(P<0.05).Two patients,overall survival(OS)are more than 40 months in five patients.Five patients' OS was 29.8 months.Conclusion This research preliminary showed chemotherapy combined with autologous CIK cells sequential maintenance therapy is safe and effective for the elderly patients with AML.