间充质干细胞输注对移植物抗宿主病中不同受损器官的治疗效果

Therapeutic effects of mesenchymal stem cell transfusion on different damaged organs in graft-versus-host disease

背景:间充质干细胞的免疫学特性为其作为临床治疗移植物抗宿主病提供了可能。目的:分析骨髓间充质干细胞输注的安全性以及对移植物抗宿主病中不同受损器官的治疗效果。方法:8例恶性血液病患者在异基因造血干细胞移植后出现激素耐药重度急性移植物抗宿主病,在原有免疫抑制治疗的基础上给予输注间充质干细胞1×106/kg,分别输注1-4次。结果与结论:8例患者中6例经间充质干细胞治疗有效(2例完全缓解,4例部分缓解),2例无效。5例皮肤病变中4例得到改善,1例无效;3例口腔病变中2例得到完全缓解,1例部分缓解。2例肝脏病变以及2例胃肠道病变均获得完全缓解。3例眼睛病变、1例闭塞性支气管炎以及1例泌尿系统移植物抗宿主病无效。在随访中位时间28(7-62)个月期间,8例患者中3例在输注间充质干细胞后3个月内出现移植后淋巴增殖性疾病。结果表明间充质干细胞输注对皮肤、肝脏、胃肠道、口腔移植物抗宿主病有一定的疗效,对眼睛、肺部以及泌尿系统的移植物抗宿主病无效果。间充质干细胞输注过程安全,间充质干细胞的使用是否与移植后淋巴增殖性疾病的发生有关需要更多病例资料的证实。

BACKGROUND：Because of their immunological properties, bone marrow mesenchymal stem cells transfusion is developed as a new treatment for refractory graft-versus-host disease. OBJECTIVE：To analyze the safety and curative effect of bone marrow mesenchymal stem cells transfusion on treating different organ damages in graft-versus-host disease after al ogeneic hematopoietic stem celltransplantation. METHODS：Eight patients with malignant hematologic disease were included in this study. The patients developed severe steroid-resistant graft-versus-host disease after al ogeneic hematopoietic stem celltransplantation and received transfusion of mesenchymal stme cell（1×106 of immunosuppressive agent. RESULTS AND CONCLUSION：For the total y eight patients, six got response （two cases of complete remission, and four cases of partial remission） and two showed no remission. Four of five cutaneous damages were ameliorated and one showed no effect. For three cases of oral graft-versus-host disease, two acquired complete remission and one showed partial remission. Two cases of liver graft-versus-host disease and two cases of astro-intestinal graft-versus-host disease obtained complete remission. No response was displayed to three cases of ocular graft-versus-host disease, one case of bronchiolitis obliterans, and one case of urinary graft-versus-host disease. In the median fol ow-up of 28 months （7-62 months）, three patients developed posttransplant lymphoproliferative disorders within 3 months after mesenchymal stem cells transfusion. Administration of mesenchymal stem cells is safe for treatment of severe graft-versus-host disease after al ogeneic hematopoietic stem celltransplantation. Mesenchymal stem cells transfusion may be a promising/kg） together with the primary therapy therapy for refractory cutaneous , astro-intestinal, liver and oral graft-versus-host disease but not for pulmonary, ocular and urinary graft-versus-host disease. Whether mesenchymal stem cells transfusion is associated with posttransplant lymphoproliferative disorders needs more case data.