Induction of remission of severe and refractory rheumatoid arthritis by allogeneic mixed chimerism
Induction of remission of severe and refractory rheumatoid arthritis by allogeneic mixed chimerism
复制标题
DOI：
10.1002/art.20451
复制
发表时间：
2004-08-01
影响因子：
--
通讯作者：
Barr, WG
中科院分区：
文献类型：
--
作者：
Burt, RK;Oyama, Y;Barr, WG
本报告描述了首例因类风湿关节炎（RA）而进行的异基因造血干细胞移植（HSCT）。我们采用非清髓性异基因HSCT治疗一名52岁女性，她患有难治性RA且预后不良（24个关节肿胀，38个关节受累）。她接受了氟达拉滨、环磷酰胺、阿仑单抗（CAMPATH - 1H）以及CD34 + 选择的HSCT（800万个CD34 + 供体细胞/千克）治疗；供者是与患者HLA匹配、类风湿因子阴性的姐妹。HSCT后1年，患者除了皮节水痘 - 带状疱疹病毒感染外无其他感染，也未出现急性或慢性移植物抗宿主病（GVHD）。她的RA在未使用免疫抑制或免疫调节药物的情况下持续缓解。患者是混合嵌合体，有55%的供者T（CD3 +）细胞和70%的供者髓系（CD33 +）细胞。这是首例发表的因RA而进行异基因HSCT的报告。混合嵌合状态使RA显著改善，且无GVHD。
This report describes the first allogeneic hematopoietic stem cell transplantation (HSCT) performed for the indication of rheumatoid arthritis (RA). We used nonmyeloablative allogeneic HSCT to treat a 52-year-old woman who had treatment-refractory RA and a poor prognosis (24 swollen and 38 involved joints). She was treated with fludarabine, cyclophosphamide, CAMPATH-1H, and CD34-selected HSCT (8 million CD34+ donor cells/kg); the donor was the patient's HLA-matched, rheumatoid factor-negative sister. One year post-HSCT, the patient has had no infection except dermatomal varicella-zoster virus infection and no acute or chronic graft-versus-host disease (GVHD). Her RA has remained in remission with no immunosuppressive or immunomodulatory medications. The patient is a mixed chimera, with 55% donor T (CD3+) cells and 70% donor myeloid (CD33+) cells. This is the first published report of allogeneic HSCT performed for the indication of RA. Mixed chimerism has resulted in marked amelioration of RA, without GVHD.