自体外周血CD(34)(+)细胞移植治疗重症自身免疫性疾病的初步研究

[A preliminary study on the treatment of severe autoimmune disease by autologous peripheral CD(34)(+) cell transplantation].

作者信息

Zhou Dao-bin, Zhao Yan, Wang Shu-jie, Li Tai-sheng, Zhang Jie-ping, Zhao Yong-qiang, Duan Yun, Zhang Feng-chun, Tang Fu-lin, Bai Lian-jun, Cui Wei, Wu Pei, Zhang Fu-quan, Shen Ti

机构信息

Department of Hematology, Peking Union Hospital, CAMS & PUMC, Beijing 100730, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2003 Sep;24(9):460-3.

PMID:14575587

Abstract

OBJECTIVE

To evaluate the feasibility of autologous peripheral CD(34)(+) cell transplantation for the treatment of severe autoimmune disease.

METHODS

Ten patients received mobilized and purified CD(34)(+) cells transplantation. The mobilization regimen was CTX plus rhG-CSF and the CD(34)(+) cells were selected by CliniMACS. (1.98 +/- 0.95) x 10(8) CD(34)(+) cells were obtained. The purity of CD(34)(+) cells was (91.4 +/- 10.6)% and the recovering rate was (60.5 +/- 19.8)%. The conditioning regimens were CTX (200 mg/kg) plus ATG (90 mg/kg) or CTX (150 mg/kg) plus TBI (4 - 6 Gy). (2.14 +/- 1.05) x 10(6)/kg CD(34)(+) cells were infused. The time of ANC >or= 0.5 x 10(9)/L was 8.6 +/- 2.5 days, and platelet >or= 20 x 10(9)/L was 9.0 +/- 5.2 days. After the hematopoietic recovery, the levels of CD(3)(+) T cell, CD(19)(+) B cells and CD(16)(+)CD(56)(+) NK cells were all below that of pre-transplantation. The main transplant-related complication was CMV infection. The transplant-related mortality was 2/10. All patients who survived showed improvement of the disease with DAI score decreasing from 17 to 4 in systemic lupus erythematosus patients, DAS 28 score from 6.4 to 1.8 in rheumatoid arthritis patients.

CONCLUSION

The result suggests that autologous peripheral CD(34)(+) cell transplantation is an alternative choice for the treatment of severe autoimmune disease. The short-term outcome is satisfying.

摘要

目的

评估自体外周血CD(34)(+)细胞移植治疗重症自身免疫性疾病的可行性。

方法

10例患者接受动员并纯化的CD(34)(+)细胞移植。动员方案为环磷酰胺（CTX）加重组人粒细胞集落刺激因子（rhG-CSF），采用CliniMACS分选CD(34)(+)细胞。获得(1.98±0.95)×10(8)个CD(34)(+)细胞。CD(34)(+)细胞纯度为(91.4±10.6)%，回收率为(60.5±19.8)%。预处理方案为CTX（200mg/kg）加抗胸腺细胞球蛋白（ATG，90mg/kg）或CTX（150mg/kg）加全身照射（TBI，4 - 6Gy）。输注(2.14±1.05)×10(6)/kg CD(34)(+)细胞。中性粒细胞绝对值（ANC）≥0.5×10(9)/L的时间为8.6±2.5天，血小板≥20×10(9)/L的时间为9.0±5.2天。造血恢复后，CD(3)(+)T细胞、CD(19)(+)B细胞和CD(16)(+)CD(56)(+)NK细胞水平均低于移植前。主要的移植相关并发症为巨细胞病毒（CMV）感染。移植相关死亡率为2/10。所有存活患者疾病均有改善，系统性红斑狼疮患者疾病活动指数（DAI）评分从17降至4，类风湿关节炎患者疾病活动度评分（DAS 28）从6.4降至1.8。