CAJ | 학술논문

背景:骨髓间充质干细胞由于具有免疫调节能力使其能用于治疗移植物抗宿主病,特别是治疗急性移植物抗宿主病己获临床成功,但是对于治疗慢性移植物抗宿主病,特别是硬皮病样慢性移植物抗宿主病(ScGVHD)的研究报道还很少.目的:评价骨髓间充质干细胞治疗ScGVHD的有效性及安全性,同时探讨取得疗效的免疫学机制.方法:于2006-09/2008-08在解放军307医院血液移植科接受骨髓间充质干细胞髓内注射ScGVHD患者4例,男3例,女1例;中位年龄41岁.骨髓间充质干细胞髓内注射具体方法:取右髂前上棘为穿刺注射点,注射骨髓间充质干细胞悬液,4例患者的给药剂量基本控制在(1.0～2.0)×10~7个细胞/次,行间断多次给药.合并用药亦有差异,但都为治疗ScGVHD的传统药物,且用量大为减少.结果与结论:经过多次骨髓内输注骨髓间充质干细胞后,Th细胞的比例发生了明显的变化,Th1的比例上调,Th2的比例相应的下调,从而使两者达到了新的平衡点.与之相应,患者的临床症状也逐渐好转.而且在骨髓间充质干细胞治疗的随访期内,患者的生命体征和实验室检查指标均未发现异常,也未出现白血病的复发.证明骨髓间充质干细胞对ScGVHD是有治疗效果的,为临床治疗ScGVHD开辟了一个新的方法,从而能提高自血病患者骨髓移植的存活率.但由于样本数较少,需要进一步扩大规模进行临床研究,以进一步证实其安全性和疗效.
배경:골수간충질간세포유우구유면역조절능력사기능용우치료이식물항숙주병,특별시치료급성이식물항숙주병기획림상성공,단시대우치료만성이식물항숙주병,특별시경피병양만성이식물항숙주병(ScGVHD)적연구보도환흔소.목적:평개골수간충질간세포치료ScGVHD적유효성급안전성,동시탐토취득료효적면역학궤제.방법:우2006-09/2008-08재해방군307의원혈액이식과접수골수간충질간세포수내주사ScGVHD환자4례,남3례,녀1례;중위년령41세.골수간충질간세포수내주사구체방법:취우가전상극위천자주사점,주사골수간충질간세포현액,4례환자적급약제량기본공제재(1.0～2.0)×10~7개세포/차,행간단다차급약.합병용약역유차이,단도위치료ScGVHD적전통약물,차용량대위감소.결과여결론:경과다차골수내수주골수간충질간세포후,Th세포적비례발생료명현적변화,Th1적비례상조,Th2적비례상응적하조,종이사량자체도료신적평형점.여지상응,환자적림상증상야축점호전.이차재골수간충질간세포치료적수방기내,환자적생명체정화실험실검사지표균미발현이상,야미출현백혈병적복발.증명골수간충질간세포대ScGVHD시유치료효과적,위림상치료ScGVHD개벽료일개신적방법,종이능제고자혈병환자골수이식적존활솔.단유우양본수교소,수요진일보확대규모진행림상연구,이진일보증실기안전성화료효.
BACKGROUND:The immunomodulatory ability of bone marrow mesenchymal stem cells(BMSCs)gives it a promising future in treating graft-versus-host disease(GVHD),especially with previous success in treating patients with acute GVHD.However,there are fewer reports concerning BMSCs in treating chronic GVHD,particularly for sclerodermatous chronic graft-versus-host disease(ScGVHD).OBJECTIVE:To evaluate the efficacy and safety of treatment of BMSCs for ScGVHD,and to primarily explore the immunological mechanism of clinical efficacy.METHODS:Four ScGVHD patients at the Affiliated Hospital of Academy of Military Medicine Science,between September 2006 and August 2008,were enrolled for this trial.The median patient age was 41 years,1 female and 3 male.The patients received BMSCs infusion at a dose of(1.0～2.0)×10~7 cells every time by intrabone marrow injection from the anterosuperior iliac spine and BMSCs from the same donor for the same patient were infused more than once.Concomitant medications for ScGVHD were individualized for each patient,but all were current standard medicines and the doses were significantly tapered.RESULTS AND CONCLUTION:After BMSCs infusion,the ratio of Th1 to Th2 was dramatically overturned,with an increase of Th1 and a decrease of Th2 reaching at a new balance.Correspondingly,symptoms of all the four patients gradually improved.During the course of BMSCs treatment,the life signs and laboratory results from the recipients remained normal.By the time of this report,there has been no recurrence of leukemia in the four patients.Although this study alone cannot guarantee the application of BMSCs in ScGVHD,the results are strongly in favor of the idea that the BMSCs treatment for ScGVHD patients is therapeutically practical without any detectable side effects,which may provide a new insight into the matter of treating ScGVHD clinically,thus will greatly increase the survival rate of leukemia after allogeneic bone marrow transplantation.