摘要
目的 探讨自体外周血CD34+ 细胞移植治疗严重自身免疫性疾病的干细胞动员、细胞采集和分选、预处理和并发症处理等问题。方法 10例重度自身免疫性疾病患者接受自体外周血CD34+细胞移植治疗。采用环磷酰胺 (CTX) +rhG CSF方案动员外周血干细胞 ,并以CliniMACS细胞分选仪分选CD34+ 细胞 ,适时用CTX +抗胸腺细胞球蛋白 (7例 )或CTX +全身照射 (3例 )两种预处理方案后 ,进行CD34+ 细胞回输的方法治疗。结果 经CTX +rhG CSF方案动员并以CliniMACS细胞分选仪分选后 ,可获得 (1.98± 0 .95 )× 10 8的CD34+ 细胞 ,其纯度为 (91.4± 10 .6 ) % ,回收率为 (6 0 .5± 19.8) %。在回输(2 .14± 1.0 5 )× 10 6 kg的CD34+ 细胞后 ,ANC≥ 0 .5× 10 9 L的时间为 (8.6± 2 .5 )d ,血小板升至 2 0× 10 9 L的时间为 (9.0± 5 .2 )d。在造血恢复后 ,所有CD3+ 细胞、CD1 9+ 细胞和CD1 6+ CD56+ 细胞均未恢复至移植前状态。在造血和免疫抑制时 ,巨细胞病毒感染的发生率较高。 2例患者死于移植相关并发症。所有患者近期疗效满意 ,6例系统性红斑狼疮患者DAI评分由移植前的平均 17分降为移植后的 4分 ;类风湿关节炎患者DAS2 8评分由 6 .4分降至 1.8分 ;干燥综合征患者的症状和体征均明显缓解。结论 对常规治疗无效的严?
Objective To evaluate the feasibility of autologous peripheral CD_ 34 + cell transplantation for the treatment of severe autoimmune disease. Methods Ten patients received mobilized and purified CD_ 34 + cells transplantation. The mobilization regimen was CTX plus rhG-CSF and the CD_ 34 + cells were selected by CliniMACS. (1.98±0.95)×10 8 CD_ 34 + cells were obtained. The purity of CD_ 34 + cells was (91.4±10.6)% and the recovering rate was (60.5±19.8)%. The conditioning regimens were CTX (200 mg/kg) plus ATG (90 mg/kg) or CTX (150 mg/kg) plus TBI (4～6 Gy). (2.14±1.05)×10 6/kg CD_ 34 + cells were infused. The time of ANC≥0.5×10 9/L was 8.6±2.5 days,and platelet ≥20×10 9/L was 9.0±5.2 days. After the hematopoietic recovery, the levels of CD_3 + T cell, CD_ 19 + B cells and CD_ 16 +CD_ 56 + NK cells were all below that of pre-transplantation. The main transplant-related complication was CMV infection. The transplant-related mortality was 2/10. All patients who survived showed improvement of the disease with DAI score decreasing from 17 to 4 in systemic lupus erythematosus patients, DAS 28 score from 6.4 to 1.8 in rheumatoid arthritis patients. Conclusion The result suggests that autologous peripheral CD_ 34 + cell transplantation is an alternative choice for the treatment of severe autoimmune disease. The short-term outcome is satisfying.
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2003年第9期460-463,共4页
Chinese Journal of Hematology
