自体造血干细胞移植治疗多发性硬化的疗效及免疫学改变

目的研究自体造血干细胞移植(ASCT)治疗进展型多发性硬化(MS)临床应用的可行性及免疫学改变。方法对10例处于继发进展期的MS患者进行了ASCT。移植后依据扩展疾病状态(EDSS)评分、发作次数、核磁共振(MRI)检查及免疫抑制药物的需求指标评定疗效。用流式细胞仪方法动态检测移植前后MS患者T淋巴细胞亚群、CD4 CD25 细胞及Th2细胞的改变。结果移植相关死亡率为零。随访观察9~26个月(平均17.9个月),至随访截止时有1例患者出现复发;4例患者处于疾病无进展状态;5例患者病情明显好转。除1例复发者外,全部患者在ASCT后不需要免疫抑制剂治疗。移植前、后相同观察期内发作次数由24次减至1次。移植后6个月MRI检查病灶由移植前的92处减少至6处。移植后1a(n=6)CD3 细胞、CD8 细胞及CD4 CD25 细胞的恢复高于移植前水平;CD4 细胞及CD3 CD4-CD8-细胞的恢复未达到移植前水平。结论ASCT治疗进展型MS患者是安全、有效的;移植后CD4 细胞及CD4-CD8-细胞的恢复较慢,CD4 CD25 细胞的恢复高于移植前水平。

Therapeutic efficacy of autologous stem cell transplantation in the treatment of progressive multiple sclerosis and its immunological changing

Objective To research the practical feasibility of autologous stem cell transplantation (ASCT) in the treatment of progressive multiple sclerosis (MS) and its related immunological changes. Methods Designed ASCT was performed in 10 patients with secondary progressive MS. Therapeutic efficacy was evaluated by the EDSS, the attacking times, the focus on MRI, and the immunosuppressive medication requirements. Flow cytometry was used for detecting T cell-subsets, CD4 CD25 cells and Th2 cells in MS patients of pre-and post-ASCT. Results No deaths occurred following the treatment. The median follow-up after APBSCT was 17.9 months (9-26 months). A total of 4 patients demonstrated in a stable status without exacerbation; five patients shown remarkable improvement in neurological manifestations; one patient demonstrated clinical evidence of recurrence of active symptoms of MS. All of them have discontinued immuno-suppressive medications exception one of patient with relapse. The attacking times decreased from 24 to 1 during the same observation period of pre-and post-ASCT, and the focus on MRI diminished from 92 of pre-ASCT to 6 of the 6 months post-APBSCT. Of the 6 patients with followed up of more than 1 year, the recovery of CD3 , CD8 , and CD4 CD25 cells of 1 year post-ASCT was higher than that of pre-ASCT, but CD4 and CD4-CD8-cells had not reached the level of pre-ASCT. Conclusion ASCT is safe and efficacious in treatment of progressive MS patients. The recovery of different T-subgroups is unbalance: CD4 and CD4-CD8-cells has not got the recovery untill one year post-APBSCT; CD4 CD25 cells of 1 year post-ASCT are higher than that of pre-ASCT in all of 6 MS patients.