On reversing the persistence of memory: Hematopoietic stem cell transplant for autoimmune disease in the first ten years
On reversing the persistence of memory: Hematopoietic stem cell transplant for autoimmune disease in the first ten years
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DOI：
10.1016/j.jaut.2007.12.001
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发表时间：
2008-05-01
影响因子：
12.8
通讯作者：
Gershwin, M. Eric
中科院分区：
文献类型：
--
作者：
Deane, Sean;Meyers, Frederick J.;Gershwin, M. Eric
在上个世纪，自身免疫性疾病患者的治疗有了非凡的历史。在开发新的非甾体抗炎药和皮质类固醇之前，对自身免疫性疾病患者的护理仅限于阿司匹林和一般的顺势疗法，如石蜡。在过去的30年里，细胞毒性药物如甲氨蝶呤和环磷酰胺的引入和接受极大地促进了严重自身免疫性疾病患者的治疗。然而，细胞毒性药物在重症患者中的使用和剂量增加受到毒性和与终生累积剂量相关的继发性恶性肿瘤的可能性的限制。随着造血干细胞移植逐渐成为治疗某些恶性肿瘤的既定方法，有关共存的自身免疫性疾病得到缓解的报道开始出现。随后的动物数据支持了造血干细胞移植在自身免疫性疾病的主要指征中的作用。在这些报告的基础上，造血干细胞移植用于自身免疫性疾病的主要指征的临床试验于20世纪90年代末开始。我们回顾了十年来为这种管理自身免疫的新方法所积累的经验数据。(C) 2007 Elsevier Ltd.版权所有。
There has been a remarkable history in the treatment of patients with autoimmune disease in the last century. Prior to the development of newer NSAIDs and corticosteroids, the care of patients with autoimmune disease was limited to aspirin and generally homeopathic therapies such as paraffin. In the last 30 years, the introduction and acceptance of cytotoxic drugs such as methotrexate and cyclophosphamide have greatly advanced the treatment of patients with severe autoimmune diseases. However, the use and dose escalation of cytotoxic agents in severely ill patients is limited by toxicity and the potential for secondary malignancies that correlate with cumulative lifetime dosing. As hematopoietic stem cell transplant grew to become an established procedure for certain malignancies, reports of remission of coexistent autoimmune diseases began to emerge. Animal data subsequently supported a role for hematopoietic stem cell transplants for the primary indication of autoimmune diseases. On the basis of these reports, clinical trials of hematopoietic stem cell transplants for the primary indication of autoimmune disease were initiated in the late 1990s. We review the data from a decade of experience that has now accumulated for this novel approach to the management of autoimmunity. (C) 2007 Elsevier Ltd. All rights reserved.