雷帕霉素治疗异基因造血干细胞移植后移植物抗宿主病的初步研究

Primary study on treatment of rapamycin in graft versus host disease after allogeneic hematopoietic stem cell transplant

目的探讨新型免疫抑制剂雷帕霉素(西罗莫司)对异基因造血干细胞移植后急性重度移植物抗宿主病(GVHD)及慢性广泛型GVHD的免疫抑制作用。方法选取我科1999—2008年已行异基因造血干细胞移植患者,使用雷帕霉素联合基础免疫抑制剂治疗GVHD。结果1例患者获得完全缓解,2例明显改善,其中2例患者慢性广泛性GVHD持续好转并无病存活,其余5例患者死亡。结论雷帕霉素可以抑制T淋巴细胞增殖效应,增强免疫耐受,对难治性GVHD有一定疗效,但其不良反应大,对骨髓抑制明显,易发生严重感染、出血等并发症。

Objective To discuss the immunosuppressive action of rapamycin which is a new kind of immunosuppressive agent in acute and chronic extensive graft versus host disease after allogeneic hematopoietic stem cell transplant. Methods We selected eight patients who have been received allo--HSCT from 1999 to 2008. All patients received the combination of rapamycin and basic immunosuppressant to treat GVHD. Results One obtained complete remission, two patients improved obviously, two of them who had chronic extensive graft versus host disease improved persistently and remained disease-free survival. Five patients died. Conclusions Rapamycin can inhibit T--lymphocyte proliferation and enhance immunotolerance. It had curative effect in refractory GVHD, but it had more side effect and obviously suppressed bone marrow and often developed complications of severe infection and haemorrhagia.