Course of Crohn's disease after allogeneic marrow transplantation
Course of Crohn's disease after allogeneic marrow transplantation
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DOI：
10.1016/s0016-5085(98)70525-6
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发表时间：
1998-03-01
期刊：
影响因子：
29.4
通讯作者：
McDonald, GB
中科院分区：
文献类型：
--
作者：
Lopez-Cubero, SO;Sullivan, KM;McDonald, GB
背景与目的：异基因骨髓移植后几种自身免疫性疾病的缓解已有报道。这项研究的目的是确定健康异基因供者的造血细胞移植是否改变了克罗恩病的自然病史。方法：1982~1992年，对6例克隆氏病合并白血病患者行异基因骨髓移植，并进行临床随访。结果：5例患者移植前有活动性克罗恩病，3例有硬化性胆管炎的临床证据。4例骨髓供者为人类白细胞抗原相合同胞，1例血缘关系供者DR基因不匹配，1例非血缘关系供者为人类白细胞抗原相合。1例于移植后97天死于败血症，5例分别于移植后4.5、5.8、8.4、9.9、15.3年观察。在接受评估的5名患者中，有4名在移植后没有克罗恩病的体征或症状。1例供者-宿主混合造血嵌合体患者在移植后1.5年复发克罗恩病。结论：5例患者中有4例在异基因造血细胞移植后随访4.5~15.3年，无克罗恩病发生。这些观察表明，宿主免疫失调在克罗恩病的永久存在中发挥了作用，这种疾病可以通过异基因造血细胞移植来纠正。
Background & Aims: Remission of several autoimmune diseases has been described after allogeneic marrow transplantation. The aim of this study was to determine if the natural history of Crohn's disease was altered by hematopoietic cell transplants from healthy allogeneic donors. Methods: Between 1982 and 1992, 6 patients with Crohn's disease and leukemia underwent allogeneic marrow transplantation and were followed up clinically. Results: Five patients had active Crohn's disease before transplantation, and 3 had clinical evidence of sclerosing cholangitis. Four marrow donors were HLA-identical siblings, 1 related donor was mismatched at the DR locus, and 1 unrelated donor was HLA-matched. One patient died of septicemia 97 days after transplantation; 5 patients were observed for 4.5, 5.8, 8.4, 9.9, and 15.3 years after transplantation. Four of 5 patients evaluated had no signs or symptoms of Crohn's disease after transplantation. One patient with mixed donor-host hematopoietic chimerism had a relapse of Crohn's disease 1.5 years after transplantation. Conclusions: Four of 5 patients followed up for 4.5 to 15.3 years after allogeneic hematopoietic cell transplantation remained free of Crohn's disease. These observations suggest that host immune dysregulation plays a role in the perpetuation of Crohn's disease that can be corrected by allogeneic hematopoietic cell transplantation.