Assessment of the use of immunosuppressants combined with cord blood for severe aplastic anemia.
BACKGROUND
The objective of this study was two-fold: 1) to investigate the changes of cytokines concentration in relation to severe aplastic anemia (SAA) when treated with immunosuppressants combined with cord blood (IS + CBI). and 2) to assess the curative effect of umbilical cord blood chimerism engraftment.


METHODS
We selected 43 patients with SAA all treated with IS + CBI (newly diagnosed group). Among them, a total of 33 patients were treated effectively (effective group) while 10 cases were treated invalidly (invalid group). An additional 20 healthy individuals were selected as control (control group). The expression levels of IL-17, IL-22 and other cytokines in each group were detected by ELISA. The engraftment of cord blood stem cells was detected by using short tandem repeat-polymerase chain reaction (STR-PCR).


RESULTS
1. IL-17, IL-22 and other cytokines expressions in the newly diagnosed group were significantly higher than in the control group. 2. After six months, the levels in the effective group were significantly lower than pre-therapy levels (P < 0.05). The levels in the invalid group did not differ to those observed prior treatment. 3. After one and three months of treatment, a small amount of engraftment was found in the effective group. However, after six months, transplant rejection was observed in all patients. No effective engraftment was observed in the invalid group.


CONCLUSIONS
1) Th17 and Th22 producing cells in SAA patients significantly increased indicating a positive correlation between these biomarkers and the progression of SAA. 2) During the IS + CBI treatment the maintenance of a normal hematopoietic function depended on immunesup-pressants. Early umbilical cord blood chimerism engraftment may promote hematopoietic recovery.
Department of Hematology, Jinan Military General Hospital, Jinan, Shandong 250031, China.
Zhe
Z
Yu
Fang
F
Zhou
Lin-Fu
LF
Ge
Xi-Min
XM
Liu
Yuan
Y
Fang
Lin-Na
LN
Xie
Fan-Sheng
FS
Kong
Ning-Xia
NX
Song
Qing-Qing
QQ
Yu
D000293:Adolescent; D000328:Adult; D000741:Anemia, Aplastic / Q000097:blood / Q000175:diagnosis / Q000628:therapy*; D015415:Biomarkers / Q000097:blood; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D036101:Cord Blood Stem Cell Transplantation / Q000009:adverse effects; D016207:Cytokines / Q000097:blood; D005260:Female; D006084:Graft Rejection / Q000097:blood / Q000276:immunology; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D012720:Severity of Illness Index; D013997:Time Factors; D018183:Transplantation Chimera; D016896:Treatment Outcome; D055815:Young Adult
D015415:Biomarkers; D016207:Cytokines; D007166:Immunosuppressive Agents