Lopez-Cubero S O, Sullivan K M, McDonald G B
Clinical Research Division, Fred Hutchinson Cancer Research Center, and University of Washington School of Medicine, Seattle 98109-1024, USA.
Gastroenterology. 1998 Mar;114(3):433-40. doi: 10.1016/s0016-5085(98)70525-6.
BACKGROUND & AIMS: Remission of several autoimmune diseases has been described after allogeneic marrow transplantation. The aim of this study was to determine if the natural history of Crohn's disease was altered by hematopoietic cell transplants from healthy allogeneic donors.
Between 1982 and 1992, 6 patients with Crohn's disease and leukemia underwent allogeneic marrow transplantation and were followed up clinically.
Five patients had active Crohn's disease before transplantation, and 3 had clinical evidence of sclerosing cholangitis. Four marrow donors were HLA-identical siblings, 1 related donor was mismatched at the DR locus, and 1 unrelated donor was HLA-matched. One patient died of septicemia 97 days after transplantation; 5 patients were observed for 4.5, 5.8, 8.4, 9.9, and 15.3 years after transplantation. Four of 5 patients evaluated had no signs or symptoms of Crohn's disease after transplantation. One patient with mixed donor-host hematopoietic chimerism had a relapse of Crohn's disease 1.5 years after transplantation.
Four of 5 patients followed up for 4.5 to 15.3 years after allogeneic hematopoietic cell transplantation remained free of Crohn's disease. These observations suggest that host immune dysregulation plays a role in the perpetuation of Crohn's disease that can be corrected by allogeneic hematopoietic cell transplantation.
同种异体骨髓移植后，多种自身免疫性疾病出现缓解。本研究旨在确定来自健康同种异体供者的造血细胞移植是否会改变克罗恩病的自然病程。
1982年至1992年间，6例患有克罗恩病和白血病的患者接受了同种异体骨髓移植，并进行了临床随访。
5例患者在移植前患有活动性克罗恩病，3例有硬化性胆管炎的临床证据。4例骨髓供者为HLA相合同胞，1例相关供者在DR位点不匹配，1例无关供者HLA匹配。1例患者在移植后97天死于败血症；5例患者在移植后分别观察了4.5年、5.8年、8.4年、9.9年和15.3年。5例接受评估的患者中，4例在移植后无克罗恩病的体征或症状。1例具有混合供者-宿主造血嵌合体的患者在移植后1.5年出现克罗恩病复发。
5例患者在同种异体造血细胞移植后随访4.5至15.3年，其中4例未患克罗恩病。这些观察结果表明，宿主免疫失调在克罗恩病的持续存在中起作用，而异种异体造血细胞移植可对此进行纠正。
