Al-toma Abdulbaqi, Nijeboer Petula, Bouma Gerd, Visser Otto, Mulder Chris J J
Abdulbaqi Al-toma, Department of Internal Medicine and Gastroenterology, 3430 EM Nieuwegein, The Netherlands.
World J Gastroenterol. 2014 Dec 14;20(46):17368-75. doi: 10.3748/wjg.v20.i46.17368.
Both, autologous and allogeneic hematopoietic stem cell transplantation (HSCT) can be used to cure or ameliorate a variety of malignant and non-malignant diseases. The rationale behind this strategy is based on the concept of immunoablation using high-dose chemotherapy, with subsequent regeneration of naive T-lymphocytes derived from reinfused hematopoietic progenitor cells. In addition, the use of HSCT allows for the administration of high-dose chemotherapy (whether or not combined with immunomodulating agents such as antithymocyte globulin) resulting in a prompt remission in therapy-refractory patients. This review gives an update of the major areas of successful uses of HSCT in non-malignant gastrointestinal disorders. A Medline search has been conducted and all relevant published data were analyzed. HSCT has been proved successful in treating refractory Crohn's disease (CD). Patients with refractory celiac disease type II and a high risk of developing enteropathy associated T-cell lymphoma have shown promising improvement. Data concerning HSCT and mesenchymal SCT in end-stage chronic liver diseases are encouraging. In refractory autoimmune gastrointestinal diseases high-dose chemotherapy followed by HSCT seems feasible and safe and might result in long-term improvement of disease activity. Mesenchymal SCT for a selected group of CD is promising and may represent a significant therapeutic alternative in treating fistulas in CD.
自体和异基因造血干细胞移植（HSCT）均可用于治愈或改善多种恶性和非恶性疾病。该策略背后的基本原理基于使用大剂量化疗进行免疫消融的概念，随后再输注造血祖细胞衍生的初始T淋巴细胞实现再生。此外，HSCT的应用使得大剂量化疗（无论是否联合抗胸腺细胞球蛋白等免疫调节药物）得以实施，从而使治疗难治性患者迅速缓解。本综述更新了HSCT在非恶性胃肠道疾病中成功应用的主要领域。我们进行了Medline检索并分析了所有相关的已发表数据。HSCT已被证明在治疗难治性克罗恩病（CD）方面是成功的。II型难治性乳糜泻且发生肠病相关T细胞淋巴瘤风险高的患者已显示出有希望的改善。关于HSCT和间充质干细胞移植用于终末期慢性肝病的数据令人鼓舞。在难治性自身免疫性胃肠道疾病中，大剂量化疗后进行HSCT似乎可行且安全，可能会使疾病活动得到长期改善。针对选定的一组CD患者进行间充质干细胞移植前景广阔，可能是治疗CD瘘管的一种重要治疗选择。
