Marmont A M
Division of Haematology, S. Martino's Hospital, Genova, Italy.
Lupus. 1993 Jun;2(3):151-6. doi: 10.1177/096120339300200304.
The impressive prolongation of survival has been the most important progress made in clinical systemic lupus erythematosus (SLE). Quality of life has also greatly improved, including pregnancy. However, persisting disease and therapy-related morbidity outcomes justify new approaches, different from the usual long-term palliative immunosuppression. Haematopoietic stem cells (HSCs) from healthy histocompatible mice are capable of curing murine SLE after eradication of the original HSCs with total body irradiation. Syngeneic and even autologous HSCs are also capable of curing induced experimental autoimmune diseases such as adjuvant arthritis and experimental allergic encephalomyelitis. In man allogeneic bone-marrow transplantation (BMT) is becoming progressively safer, but cannot yet be offered to SLE patients. However, syngeneic transplants from twins non-concordant for the disease would be justified. Conditioning with high-dose cyclophosphamide followed by autologous HSC rescue, from the marrow and/or from the peripheral blood, may already be regarded as a powerful immunosuppressive procedure for selected cases of SLE and other severe autoimmune diseases. Autologous transplant procedures are not saddled with the immunologic problems of allo-BMT. Although eradication of SLE may not be achieved by auto-BMT, minimal residual immunologic disease can be suppressed or controlled, and long-term self-maintained remissions may be expected.
生存率的显著提高是系统性红斑狼疮（SLE）临床治疗取得的最重要进展。生活质量也有了很大改善，包括妊娠方面。然而，疾病的持续存在以及与治疗相关的发病结果表明需要新的治疗方法，这与常规的长期姑息性免疫抑制不同。来自健康组织相容性小鼠的造血干细胞（HSC）在通过全身照射根除原始HSC后能够治愈小鼠SLE。同基因甚至自体HSC也能够治愈诱导性实验性自身免疫性疾病，如佐剂性关节炎和实验性过敏性脑脊髓炎。在人类中，异基因骨髓移植（BMT）正变得越来越安全，但仍不能应用于SLE患者。然而，对疾病不一致的双胞胎进行同基因移植是合理的。用高剂量环磷酰胺进行预处理，随后从骨髓和/或外周血中进行自体HSC挽救，对于某些SLE和其他严重自身免疫性疾病病例而言，可能已经被视为一种强大的免疫抑制程序。自体移植程序不存在异基因BMT的免疫问题。虽然自体BMT可能无法实现SLE的根除，但可以抑制或控制最小残留免疫疾病，并有望实现长期自我维持缓解。
