Autologous Hematopoietic Stem Cell Transplantation for Crohn’s Diseases - 5 Cases Report.

Nowadays it is widely used as glucocorticoids, ortho-oxybenzoic acid, immunosuppressive agents and biological agents for Crohn’s Disease. But all these agents can only control the symptoms rather than curing the diseases. About 70% patients need surgery in the course. 5 patents of Crohn’s Diseases have received AHSCT in our department since 2004. These patients, including 3 male and 2 female, with a mean age of 32 (range, 23~46), were final confirmed by enteroscope and histology. The mean CDAI of these patients was 213 points (range, 170~256), and the mean interval between invasion and transplantation was 63 months (range, 27~132 months). All the patients had mild or severe diarrhea and abdominal pain, one of them have a 6cm×7cm lump touchable in the abdominal region, while one of them complicated with vesicorectal fistula. These patients were mainly treated with glucocorticoids, SASP, cyclophosphamide (CTX), et al, which didn’t control the condition. Mobilization program was CTX 2g/m² for 2 days and G-CSF 5~10 μg/kg/d on the 5th day of medication. Leukapheresis was initiated when WBC>5.0×10⁹/L. The collections of CD34+ cells from two cases were over 4×10⁶/kg, and ClinMACs cell separation system was used to purify the CD34+ cells and to deplete T cells. Two collections of CD34+ cells were 1.3×10⁶/kg and 2.8×10⁶/kg, respectively, and then were kept in −80°. And the other case failed in the collection, and then was treated with bone marrow transplantation. The conditioning programs were MC (CTX 60mg/kg -2, -1d;melphalan 140mg/m² -2d) for one case, and CTX 50mg/kg×4d for the other 4 cases. 2 of the 3 patients without in vitro purification of CD34+ cells to deplete T cells were treated with rabbit antithymocyte globulin 5 mg/kg on day-2 and day -1 for T cell depletion. The mean CD34+ cells infused was 1.4×10⁶/kg(range, 1.3×10⁶/kg~2.8×10⁶/kg). Neutrophile granulocyteand>0.5×10⁹/L occurred at day +10~+12, while platelet>2.0×10⁹/L occurred at day +9~+11. Fever occurred in all patients in the granulocytopenia phase, and lasted from 1 to 3 weeks. One of the patients complicated with ESBL+ ichoremia, and was cured with antibiotics. After the transplantation, 2 patients were treated with prednisone 10mg/d as maintenance therapy, and the other 3 stopped using antidiarrheal and glucocorticoids. 4 patients got free of abdominal pain and diarrhea in the following 2~3 months, and the other did in 1 year. The average body weight of the patients increased 11.2 kg (range, 3~20kg) 3 months after transplantation. The mean follow-up was 16 months. 2 patients have been maintaining remission until now. The lump in the abdomen of one of these 2 patient decreased from 6×7cm to 5×5cm, which was resected 19 months after transplantation. And this patient is still in remission now. 3 patients relapsed after 4~8 months of remission. One of them relapsed 5months after transplantation and died complicated with peritonitis in 7 months. One patient relapsed in 8 months with abdominal discomfort, mild diarrhea, and decreasing of body weight. The other complicated with rectovesical fistula showed closure of syrinx by barium enema, and suffered abdominal discomfort, mild diarrhea, and decreasing of body weight too 4 months after transplantation, then relapsed with rectovesical fistula 8 months after transplantation. HSCT for Crohn’s disease is safe and effective. However, it has a comparative higher relapse rate.