Ozşahin H, Tuchschmid P, Lauener R, Waldvogel K, Nadal D, Seger R A
Division of Immunology/Hematology, University Children's Hospital, Zürich, Switzerland.
Turk J Pediatr. 1998 Apr-Jun;40(2):231-5.
A six-year-old boy with homozygous beta-thalassemia in the favorable class 1 risk group received a bone marrow transplant, from his histocompatible sister. He developed grade IV skin and eye graft-versus-host disease (GVHD) following varicella zoster reactivation. Despite the appropriate prophylactic use of cyclosporin A (CsA), methotrexate (MTX), and prompt treatment with high-dose steroids, GVHD progressed resulting in total body epidermal necrolysis. Anti-IL-2 receptor monoclonal antibodies (anti-IL-2R moAb) in combination with steroids were administered to selectively block the activated T cells. After 27 days of daily administration, followed by 17 doses of alternate-day therapy with anti-IL-2R moAb, the severe skin and eye GVHD resolved. The patient, at two years posttransplant, has full engraftment and immune reconstitution without chronic GVHD (cGVHD). In conclusion, we suggest that in the HLA-genoidentical bone marrow transplantation setting, very severe and steroid-resistant GVHD can be controlled through the use of anti-IL-2 receptor antibodies which specifically block the activated IL-2 receptor expressing T cells.
一名处于有利的1级风险组的六岁纯合β地中海贫血男孩接受了来自其组织相容性匹配姐姐的骨髓移植。在水痘带状疱疹病毒再激活后，他出现了IV级皮肤和眼部移植物抗宿主病（GVHD）。尽管适当预防性使用了环孢素A（CsA）、甲氨蝶呤（MTX），并及时用大剂量类固醇进行了治疗，但GVHD仍进展，导致全身表皮坏死松解。联合使用类固醇给予抗IL-2受体单克隆抗体（抗IL-2R单克隆抗体）以选择性阻断活化的T细胞。在每日给药27天后，随后用抗IL-2R单克隆抗体进行了17剂隔日治疗，严重的皮肤和眼部GVHD得到缓解。该患者在移植后两年实现了完全植入和免疫重建，且无慢性GVHD（cGVHD）。总之，我们建议在HLA基因相同的骨髓移植情况下，通过使用特异性阻断表达活化IL-2受体的T细胞的抗IL-2受体抗体，可以控制非常严重且对类固醇耐药的GVHD。
