Department of Haematology, Guangdong General Hospital, Academy of Medical Sciences, 106 Zhongshan Er Road, Guangzhou, Guangdong, PR China.
Bone Marrow Transplant. 2010 Dec;45(12):1732-40. doi: 10.1038/bmt.2010.195. Epub 2010 Sep 6.
Refractory chronic GVHD (cGVHD) is an important complication after allogeneic hematopoietic SCT and is prognostic of poor outcome. MSCs are involved in tissue repair and modulating immune responses in vitro and in vivo. From April 2005 to October 2008, 19 patients with refractory cGVHD were treated with MSCs derived from the BM of volunteers. The median dose of MSCs was 0.6 × 10(6) cells per kg body weight. Fourteen of 19 patients (73.7%) responded well to MSCs, achieving a CR (n=4) or a PR (n=10). The immunosuppressive agent could be tapered to less than 50% of the starting dose in 5 of 14 surviving patients, and five patients could discontinue immunosuppressive agents. The median duration between MSC administration and immunosuppressive therapy discontinuation was 324 days (range, 200-550 days). No patients experienced adverse events during or immediately after MSC infusion. The 2-year survival rate was 77.7% in this study. Clinical improvement was accompanied by the increasing ratio of CD5+CD19+/CD5-CD19+ B cells and CD8+CD28-/CD8+CD28+ T cells. In conclusion, transfusion of MSCs expanded in vitro, irrespective of the donor, might be a safe and effective salvage therapy for patients with steroid-resistant, cGVHD.
难治性慢性移植物抗宿主病（cGVHD）是异基因造血干细胞移植后的一个重要并发症，预后不良。间充质干细胞（MSCs）参与组织修复，并在体外和体内调节免疫反应。从 2005 年 4 月至 2008 年 10 月，19 例难治性 cGVHD 患者接受了志愿者骨髓来源的 MSCs 治疗。MSCs 的中位剂量为 0.6×10(6)个细胞/每千克体重。19 例患者中有 14 例（73.7%）对 MSCs 反应良好，达到完全缓解（CR，n=4）或部分缓解（PR，n=10）。在 14 例存活患者中有 5 例可将免疫抑制剂减少到起始剂量的 50%以下，5 例患者可停用免疫抑制剂。MSCs 给药与免疫抑制剂停药之间的中位时间为 324 天（范围 200-550 天）。在 MSC 输注期间或之后，没有患者发生不良事件。本研究中，2 年生存率为 77.7%。临床改善伴随着 CD5+CD19+/CD5-CD19+B 细胞和 CD8+CD28-/CD8+CD28+T 细胞的比例增加。总之，体外扩增的 MSCs 输注，无论供者如何，可能是治疗类固醇耐药性 cGVHD 患者的一种安全有效的挽救疗法。
