Snowden J A, Kearney P, Kearney A, Cooley H M, Grigg A, Jacobs P, Bergman J, Brooks P M, Biggs J C
St. Vincent's Hospital, Sydney, Australia.
Arthritis Rheum. 1998 Mar;41(3):453-9. doi: 10.1002/1529-0131(199803)41:3<453::AID-ART11>3.0.CO;2-#.
To investigate the long-term outcome of autoimmune disease following allogeneic bone marrow transplantation (BMT), and its relationship to hemopoietic chimerism.
Three previously described patients with rheumatoid arthritis (RA) who underwent allogeneic BMT for therapy-related severe aplastic anemia and 1 new patient with psoriasis who received BMT for chronic myeloid leukemia (CML) were followed up. Molecular studies were performed to assess hemopoietic and immune reconstitution in 3 cases.
In 2 of the RA patients, the RA remained in remission without treatment, with nonprogressive disease, 11 and 13 years after BMT. The third patient with RA had a relapse 2 years after BMT, although the previously aggressive disease subsequently ran an attenuated course with treatment-free remission for the last 11 years. Comparison with other cases of RA suggests that graft-versus-host disease may influence the long-term outcome, perhaps through ongoing inhibition of the immune system. In the patient with psoriasis, BMT was followed by remission, but the psoriatic rash recurred and arthropathy developed 12 months later. The psoriasis and arthropathy remained active 4.5 years post-BMT, although the CML remained in remission. Molecular studies in the 2 patients whose RA remained in continued remission and in the patient with psoriasis that relapsed confirmed complete donor hemopoietic reconstitution.
Long-term followup of autoimmune disease after allogeneic transplantation confirmed cure of the autoimmune disease in some, but eventual relapse in others. The occurrence of relapse despite complete donor hemopoietic reconstitution is evidence for the development of de novo, as opposed to persistent, disease, and is possibly related to intrinsic susceptibility of the transplanted stem cells or to host factors. There may be a relationship between remission of autoimmune disease and graft-versus-host reaction. These findings have relevance for the evolving application of stem cell transplantation as a therapy for autoimmune diseases.
研究异基因骨髓移植（BMT）后自身免疫性疾病的长期转归及其与造血嵌合体的关系。
对3例先前描述的因治疗相关的严重再生障碍性贫血接受异基因BMT的类风湿关节炎（RA）患者和1例因慢性粒细胞白血病（CML）接受BMT的新发银屑病患者进行随访。对3例患者进行分子研究以评估造血和免疫重建情况。
在2例RA患者中，BMT后11年和13年，RA未经治疗仍处于缓解期，病情无进展。第3例RA患者在BMT后2年复发，尽管先前的侵袭性疾病随后病情减轻，在过去11年中处于无治疗缓解期。与其他RA病例比较提示，移植物抗宿主病可能影响长期转归，可能是通过持续抑制免疫系统。在银屑病患者中，BMT后病情缓解，但12个月后银屑病皮疹复发并出现关节病。BMT后4.5年银屑病和关节病仍处于活动期，尽管CML仍处于缓解期。对2例RA持续缓解患者和1例复发的银屑病患者进行分子研究，证实完全为供体造血重建。
异基因移植后自身免疫性疾病的长期随访证实，部分患者的自身免疫性疾病得到治愈，但其他患者最终复发。尽管供体造血完全重建仍出现复发，这证明是新发疾病而非持续性疾病的发展，可能与移植干细胞的内在易感性或宿主因素有关。自身免疫性疾病的缓解与移植物抗宿主反应之间可能存在关联。这些发现与干细胞移植作为自身免疫性疾病治疗方法的不断发展的应用相关。
