自体外周血干细胞移植治疗难治性类风湿关节炎一例

目的 探讨自体外周血干细胞移植（APBSCT）及CD34^ 细胞分选治疗难治性类风湿关节炎（RA）的疗效、安全性及移植后免疫重建过程。方法 对1例RA患者进行APBSCT及CD34^ 细胞分选治疗。干细胞动员方案为环磷酰胺（CY）及粒细胞集落刺激因子（G－CSF）,将采集物进行CD34^ 细胞分造,－80℃冰箱冻存。经CY与抗胸腺免疫球蛋白（ATG）预处理后进行干细胞回输,并应用G－SCF协助造血重建,移植后观察临床表现及实验室指标的变化。移植前后进行淋巴细胞表型分析,监测免疫重建过程。结果 对患者成功地施行了动员及预处理方案,干细胞回输反应良好,移植后随访12个月,患者关节肿瘤完全消失,生活质量明显改善,血沉、C－反应蛋白降至正常,类风湿因子转阴;免疫重建过程正在进行。结论 APBSCT并CD34^ 细胞分选治疗RA安全性好,中短期疗效显著,移植后免疫重建过程尚需进一步随访观察。

Study of treatment of refractory rheumatoid arthritis with autologous peripheral blood stem cell transplantation

Objective To explore the efficacy, safety and immune reconstitution of autologous peripheral blood stem cell transplantation (APBSCT) using T cell depleted grafts in the treatment of refractory rheumatoid arthritis (RA). Methods One patient with RA was treated with APBSCT. The method included mobilization with 2 g/m 2 cyclophosphamide (CY) and subcutaneous injection of granulocyte colony stimulating factor (G CSF). Immunomagnetic selection of CD34 + cells from the leukapheresis products was performed to deplete potentially autoreative lymphocytes. The conditioning regimen consisted of intravenous administration of 2 g/m2 CY and 90 mg/kg ATG, with subsequent reinfusion of the graft. G CSF was used to help hematopoietic and immunologic reconstitution. Phenotype of the peripheral blood lymphocytes was analyzed to observe the immunologic reconstitution after transplantation. Results The patient completed the mobilization, conditioning regimen and transplantation successfully. The hematologic recovery was rapid and the patient achieved clinical remission. The erythrocyte sedimentation rate (ESR), C reactive protein (CRP) decreased to normal level and the rheumatoid factor (RF) turned negative after a follow up of 12 months. An ongoing course of immunologic reconstitution was observed. Conclusion APBSCT is effective and safey for refractory RA, and can induce improvement of disease activity. The course of immunologic reconstitution after transplantation remains to be observed in long term followup.