Nishimoto M, Nakamae H, Watanabe K, Koh H, Nakane T, Ohsawa M, Arakawa T, Hino M
Department of Hematology, Graduate School of Medicine, Osaka City University, Osaka, Japan.
Transplant Proc. 2013 Sep;45(7):2854-7. doi: 10.1016/j.transproceed.2013.03.049.
A 32-year-old man diagnosed with acute myelomonocytic leukemia (M4) concurrently had active Crohn's disease (CD) that was refractory to azathioprine and anti-tumor necrosis factor.
He underwent an allogeneic bone marrow transplantation from a one HLA-DR allele-mismatched unrelated donor to achieve the first complete remission of leukemia. The conditioning regimen consisted of fludarabine (180 mg/m(2)) and busulfan (8.0 mg/kg) without T-cell depletion. Graft-versus-host disease (GVHD) prophylaxis included tacrolimus and mycophenolate mofetil. Cefotaxime was prescribed for a secondary bacterial infection in a perianal abscess before the start of conditioning chemotherapy. Although low-grade diarrhea persisted, there were no signs of either acute GVHD or CD in the mucosal biopsy specimens on day 24. Complete remission of leukemia and near remission of CD were sustained for 20 months after transplantation without any immunosuppressive drug.
Allogeneic heamtopoietic stem cell transplantation with reduced-intensity conditioning is a possible therapeutic option for patients with severe and/or refractory CD.
一名32岁男性被诊断为急性粒单核细胞白血病（M4），同时患有活动性克罗恩病（CD），对硫唑嘌呤和抗肿瘤坏死因子治疗无效。
他接受了来自一名HLA-DR等位基因单倍型不匹配的无关供者的异基因骨髓移植，以实现白血病的首次完全缓解。预处理方案包括氟达拉滨（180 mg/m²）和白消安（8.0 mg/kg），未进行T细胞清除。移植物抗宿主病（GVHD）预防措施包括他克莫司和霉酚酸酯。在开始预处理化疗前，因肛周脓肿继发细菌感染而给予头孢噻肟。尽管低度腹泻持续存在，但在第24天的黏膜活检标本中未发现急性GVHD或CD的迹象。移植后20个月，白血病完全缓解，CD接近缓解，且未使用任何免疫抑制药物。
低强度预处理的异基因造血干细胞移植是重度和/或难治性CD患者的一种可能治疗选择。
