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KEMİK İLİĞİ TRANSPLANTASYONU KOMPLİKASYONLARINDAN AKUT GRAFT VERSUS HOST HASTALIĞI (aGvHH)’NIN MİKST LENFOSİT KÜLTÜR (MLC) TESTİ İLE ÖNCEDEN BELİRLENMESİ

EARLY DETERMINATION OF ACUTE GRAFT VERSUS HOST DISEASE (aGvHD) WHICH IS A COMPLICATION OF BONE MARROW TRANSPLANTATION BY USING MIXED LYMPHOCYTE CULTURE (MLC) TEST

Journal Name:

  • İstanbul Tıp Fakültesi Dergisi

Publication Year:

  • 2006

Key Words:

Keywords (Original Language):

Author NameUniversity of AuthorFaculty of Author
Abstract (2. Language): 
Objective: Standard MLC test is routinely used for patient-recipient pairs before bone marrow transplantation (BMT). This study investigates the possible predictive role of modified MLC (mMLC) (i.e. addition of several cytokines to sMLC) on posttransplant complications. Materials and methods: Ninety patient-recipient pairs undergoing BMT between 1998-2004 were included in this study. Apart from sMLC, one and two way mMLC (addition of IL-2, IL-2 + IL-4 and IL-2 + IFNγ + TNFα) were done. Results: sMLC yielded negative results in ninety patient-recipient pairs. mMLC with IL-2 addition yielded positive results in 18 cases out of 82, of which 11 received a transplant, where 9 patient experienced acute Graft versus Host Disease (aGvHD). IL-2 +IL-4 added mMLC test resulted in 9 positive results, where 4 received transplant and only 3 patients experienced aGvHD. IL-2 + IFNγ + TNFα added mMLC yielded 13 positive results, 7 received transplant and all of them experienced aGvHD. Two way MLC results were analysed by two calculations. The first formula gave 57/60 positive results; 40 received transplant, 17 experienced aGVHD, whereas with the second formula 20 positive results were seen, with 17 transplantations and 6 aGvHD. Only 17 cases had IL-2 + IL-4 added MLC test. Of these all were positive with the first formula, where 12 received transplant and 3 patient experienced aGvHD, with the second formula. Three positive results were observed, where 2 received transplant with no aGvHD complication. IL-2 + IFNγ + TNFα mMLC resulted in 49 positive results, where 35 received transplant with 16 aGVHD with the first formula, whereas with the second formula 15 positive results; 10 transplantation with 2 aGvHD. Conclusion: Addition of cytokines to sMLC is of importance in choosing the best available donor for BMT. Il-2, IL-2 + IFNγ + TNFα addition to one way mMLC rendered MLC test sensitive. This conclusion is based on a correlation of positive mMLC results with the occurence of aGvHD.
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Abstract (Original Language): 
ÖZET Amaç: Bu çal›flmada kemik ili¤i transplantasyonu (K‹T) uygulanacak hastalara, nakilden önce rutin olarak yap›lan standart mikst lenfosit kültür (sMLC) testine ek olarak sitokin ilaveleri ile yap›lan modifiye MLC (mMLC) testi ile sMLC testinin duyarl›l›¤›n›n art›r›larak, nakil sonras› ç›kabilecek komplikasyonlar›n önceden belirlenmesi amaçlanm› flt›r. Gereç ve yöntem: Bu çal›flmaya, 1998-2004 y›llar› aras›nda, ‹stanbul Üniversitesi, ‹stanbul T›p Fakültesi, T›bbi Biyoloji Anabilim Dal›’na gönderilen ve K‹T düflünüldü¤ü için rutin test yap›lan 90 hasta ve sa¤l›kl› vericileri al›nm› flt›r. Tek yönlü sMLC testine ek olarak IL-2, IL-2 + IL-4 ve IL-2 + IFNγ + TNFα ilave edilerek hem tek yönlü, hem de iki yönlü mMLC çal›fl›lm›flt›r. Bulgular: sMLC testte 90 vaka negatif sonuçlanm›flt›r. Rutin test tekni¤i d›fl›nda ayr›ca Human Leucocytes Antigen (HLA)’leri uyumsuz olan kontrol grubunda sitokin ilaveleri ile yap›lan tek yönlü MLC test sonuçlar› uyumsuz (+) ve elde edilen de¤erler (SI ile RRI) çok yüksek bulunmufltur. Tek yönlü MLC testi ile IL-2 ilave edilen 82 vakan› n 18 inde (+) sonuç al›nm›fl, 11’ine nakil yap›lm›fl ve bunlardan 9’unda akut graft versus host hastal›¤› (aGvHH) geliflmifltir. IL-2 + IL-4 ilave edilen 39 vakan›n 9’unda (+) sonuç al›nm›fl, 4’üne nakil yap›lm›fl ve 3 vakada akut aGvHH geliflmifltir. IL-2 + IFNγ + TNFα ilave edilen 77 vakan›n 13 ünde (+) sonuç al›nm›fl, 7 vakaya nakil uygulanm› fl ve hepsinde aGvHH geliflmifltir. ‹ki yönlü MLC testinde ise sonuçlar iki farkl› formül kullan›larak de¤erlendirilmifltir. IL-2 ilave edilen 60 vakada I. formüle göre 57 vakada (+) sonuç al›nm›fl, 40’›na nakil yap›lm›fl, 17 vakada aGvHH geliflmifltir. II.formüle göre 20 (+) sonuç al›nm›fl, 17’sine nakil uygulanm›fl, 6 vakada aGvHH geliflmifltir. IL-2 + IL-4 ilavesi ile 17 vaka çal›fl›lm›fl, I. formüle göre hepsinde (+) sonuç al›nm›fl, 12 vakaya nakil gerçeklefltirilmifl ve 3 vakada aGvHH geliflmifltir. II. formüle göre 3 (+) sonuç al›nm›fl, 2 sine nakil uygulanm›fl ve komplikasyon gözlenmemifltir. IL-2 + IFNγ + TNFα ile 53 vakada I.formüle göre 49’unda (+) sonuç al›nm›fl, 35’ine nakil uygulanm›fl ve 16’s›nda aGvHH geliflmifltir. II.formüle göre de 15 (+) sonuç al›nm›fl, 10’una nakil uygulanm› fl ve 2’sinde aGvHH görülmüfltür. Sonuç: K‹T planlanan al›c›ya uygun vericinin seçilmesinde uygulanan sMLC testine ilave olarak yap›lacak çal›flmalar önemlidir. IL-2 ve IL-2 + IFNγ + TNFα sitokin ilaveli tek yönlü mMLC sonuçlar› testi daha duyarl› hale getirmifl ve mMLC testindeki sonuçlar›ndaki (+)’lik ile nakil sonras› aGvHH’nin görülmesi anlaml› bulunmufltur.
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  • 3
57-62
  • Turkish

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