课件间充质干细胞在移植GVHD中应用.pptVIP

MSCs治疗激素难控制型急性GVHD8例 治疗组 例数/次数 急性GVHD 8 慢性GVHD 1 MSCs治疗1次 6 MSCs治疗2次 3 移植后急性GVHD消失 6 移植后死亡 3 巨细胞病毒胃肠炎 1 存活（2月－3年） 5 生存率明显高于同期未接受MSCs输注的GVHD患者 （P＝0.03） Ringden O，et al. Biology Blood Marrow Transplant , 2006 病例二 女孩，6岁，B-ALL（CR2） 半相合（母供女） 移植后6月，血液学复发 化疗+DLI后再次缓解 cGVHD（广泛型）,sP02:90% BO CSA/激素 间充质干细胞（2次） cGVHD明显缓解 2个月再次出现复发 * Slide 16-18: The effect of disease stage is even more apparent for allogeneic transplants. Patients receiving an HLA-identical sibling transplant for AML in remission have a 100-day mortality rate of 7 to 9%, compared to 22% for patients with active leukemia at the time of transplantation. Early mortality after an unrelated donor transplant is higher than after an HLA-identical sibling transplantation, but the rate also depends on the disease and disease stage. The causes of death in the first 100 days post-transplant mainly relate to the primary disease, graft-versus-host disease, infection and end-organ damage. After an autologous transplant, primary disease is the most commonly reported cause of death. Among allogeneic transplant recipients, unrelated donor transplants have fewer deaths related to the primary disease, however organ failure and infections are higher after unrelated donor transplants. Fig 1. Pathophysiology of acute graft-versus-host disease. During the first phase (I), recipient conditioning regimen damages patient tissues and causes release of inflammatory cytokines such as TNF-a, IL-1 and IL-7, which leads to activation of host antigen-presenting cells (APCs). In the second phase (II), host APCs activate mature donor cells through IL-12 and IL-23 to produce T helper cell type 1 (Th1) cytokines, such as IL-2, IL-6 and IFN-c. The synthesis of inflammatory cytokines is partly inhibited by IL-10. Activated Th1 cells induce increased indoleamine 2,3-dioxygenase (IDO) secretion fr