大剂量CE方案联合体内去T细胞预处理自体造血干细胞移植治疗系统性红斑狼疮

目的研究大剂量环磷酰胺和依托泊苷、体内去T淋巴细胞预处理方案自体移植治疗系统性红斑狼疮的疗效及移植后免疫指标变化。方法人组患者白体骨髓采集后体外低温保存，预处理方案：环磷酰胺60mg／kg，-1，-2，依托泊苷10～20mg／kg，-1，-2，＋2d开始应用抗胸腺细胞球蛋白（ATG）3-5mg／（kg·d），共5d。结果所有患者顺利重建造血，白细胞恢复至〉1．0×10^9／L、中性粒细胞〉0．5×10^9／L的时间为11（8～14）d，血小板〉20×10^9／L的时间为18（12-36）d，未发生移植相关死亡；移植后血沉逐渐下降、抗核抗体、抗ds-DNA、抗Sm逐渐转阴，同移植前相比差异有统计学意义．随着移植后时间延长抗ds-DNA抗体及抗Sm抗体逐渐转阴，C3、C4较治疗前升高，＋180d后逐渐进入稳定状态，差异有统计学意义。结论应用该方案进行自体移植，安全性好，疗效确切．远期效果较好，适合基层医院开展。

High dose of CE regimen combined with autologous hematopoietic stem cell transplantation pretreated with in vivo removal of T cells in the treatment of systemic lupus erythematosus

Objective To understand the efficacy of high dose Cyclophosphamide and Etoposide, together with antithy- mocyte globulin pretreated autologous transplantation in the treatment of systemic lupus erythematosus, and it＇s effect of immunological index of the body. Methods The bone marrow were store in vitro at low temperature after autologous bone marrow collection, the patients were pre-treated with cyclophosphamide 60 mg/kg, on day-1, day-2, Etoposide 10-20 mg/kg on day-l, day-2, and antithymocyte globulin （ATG） 3-5 mg/（kg·d）, for a total of 5 days from ＋2 day. Results All patients have successful hematopoietic reconstruction, time of WBC recovery to 〉1.10×10^9/L, neutrophil 〉 0.5×10^9/Lis 11 （8-14） d, time of platelet recovery to 〉20×10^9/L was 18 （12-36） d, no transplantation-related death; ESR decreased gradually after transplantation, antinuclear antibody, anti ds-DNA, anti Sm turned negative after trans- plantation, the difference has statistical significance; along with the time extension after transplantation, anti ds-DNA antibody and anti Sm antibody gradually tuned negative, C3, C4 level increased compared to pre-transplantation, on day ＋180 gradually entered into the stable state, the data has statistical significance. Conclusion The application of this therapy scheme in auto-transplantation have good safety profile, definite curative effect, suitable for primary hospi- tals for autologous transplantation.