严重多发性硬化症患者自体骨髓移植术后的T细胞急剧减少  

Intense T cell depletion followed by autologous bone marrow transplantation for severe multiple sclerosis

作　　者：Samijn J.P.A Te Boekhorst P.A.W Mondria T. R.Q. Hintzen 樊慧婷 

机构地区：[1]Department of Neurology, MS Centre ErasMS, Erasmus MC, Postbox 2040, 3000 CA Rotterdam, Netherlands

出　　处：《世界核心医学期刊文摘（神经病学分册）》2006年第5期45-46,共2页Digest of the World Core Medical Journals:Clinical Neurology

摘　　要：Background: Certain stem cell transplantation procedures might slow down inflammatory pathology in multiple sclerosis (MS). Aims: To halt disease progression in aggressive MS by a bone marrow transplantation (BMT) protocol aimed at maximum T cell suppression. Methods: Autologous BMT was performed in 14 patients with rapid secondary progressive MS (median EDSS score at baseline, 6; median disease duration, five years). To accomplish rigorous T cell ablation, a strong conditioning protocol was chosen-cyclophosphamide, total body irradiation, and antithymocyte globulin. To minimise the possibility of reinfusing mature T cells in the graft, bone marrow, not peripheral blood, was used as the CD34+ stem cell source. Results: Median follow up was 35 months (range, 23- 50). Post-transplant haemopoietic recovery was successful in all patients. Early toxicity included Epstein-Barr virus related post-transplantation lymphoproliferative disorder. Longterm effects were development of antithyroid antibodies (three) and myelodysplastic syndrome (one). One patient died of progressive disease five years after transplantation. Treatment failure, defined by EDSS increase sustained for six months or more, was seen in nine patients and stabilisation or improvement in five. Other clinical parameters generally showed the same outcome. No gadolinium enhanced lesions were seen on post-treatment magnetic resonance imaging, in either cerebral or spinal cord scans. However, cerebrospinal fluid oligoclonal bands remained positive in most cases. Conclusions: This strong immunosuppressive regimen did not prevent clinical progression in patients with aggressive secondary MS. The lack of efficacy, together with some serious side effects, does not favour the use of similar rigorous T cell depleting protocols in the future.Background： Certain stem cell transplantation procedures might slow down inflammatory pathology in multiple sclerosis （MS）. Aims： To halt disease progression in aggressive MS by a bone marrow transplantation （BMT） protocol aimed at maximum T cell suppression. Methods： Autologous BMT was performed in 14 patients with rapid secondary progressive MS （median EDSS score at baseline, 6; median disease duration, five years） . To accomplish rigorous T cell ablation, a strong conditioning protocol was chosen-cyclophosphamide, total body irradiation, and antithymocyte globulin. To minimise the possibility of reinfusing mature T cells in the graft, bone marrow, not pcripheral blood, was used as the CD34 ^＋ stem cell source. Results： Median follow up was 35 months （range, 23 - 50）. Post-transplant haemopoietic recovery was successful in all patients. Early toxicity included Epstein-Barr virus related post-transplantation lymphoproliferative disorder. Longterm effects were development of antithyroid antibodies （three） and myelodysplastic syndrome （one）. One patient died of progressive disease five years after transplantation. Treatment failure, defined by EDSS increase sustained for six months or more,

关 键 词：自体骨髓移植 多发性硬化症 移植术后 T细胞 患者 CD34^+干细胞 骨髓增生异常综合征 抗胸腺细胞球蛋白 干细胞移植手术 淋巴增生性病变 

分 类 号：R457.7[医药卫生—治疗学] R744.51[医药卫生—临床医学]