Treatment of refractory lupus erythematosus in children with high dose immunosuppressive agents

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[Abstract] objective to high dose chemotherapy can eliminate the morbid immune system, but also destroy the bone marrow hematopoietic functi

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[Abstract] objective to high dose chemotherapy can eliminate the morbid immune system, but also destroy the bone marrow hematopoietic function for hematopoietic stem cell transplantation (SCT) on hematopoietic recovery, SCT treatment of refractory systemic lupus erythematosus (SLE) has been reported, but due to its inherent disadvantages to carry out extensive, this group is the first to explore using the method of super gauge immunosuppressant, but retained the bone marrow hematopoietic function without SCT treatment in children with refractory SLE. Methods 4 patients with refractory SLE 10~16 years old, female, 3 cases of renal pathological type and WHO- proteinuria, 2 cases of autoimmune hemolytic anemia, 1 cases of immune thrombocytopenia, used including CTX and methylprednisolone double shock therapy or recurrent disease control, treatment plan: CTX 1~1.2g/m2 * 4 day, Da Rabin (Fludar) 25~30mg/m2 * 4 days, anti lymphocyte globulin (ALG pigs) 20~25mg/kg * 3 days, cyclosp A (CSA) 5~8mg/kg * 21 days; the curative effect with SLE disease activity index score (SLEDAI) assessment. Results no treatment related death; since the end of CTX, neutrophil recovery to 0.5 * 109/L average 10 days, 2 from the end of the AraC program, 16 days to neutrophil recovery to 0.5 * 109/L; after 3 weeks of treatment the average SLEDAI from 9.2 to 4.4, urinary protein decreased from 4+ to 0~1+, with severe refractory anemia or thrombocytopenia after treatment, hemoglobin and platelets were restored to normal or near normal; 4 cases were followed up for 5~16 months, the condition of basic control. Ultra routine dose of immunosuppressive treatment SLE conclusion is controlled in a certain range, without SCT can restore their blood, and a considerable degree of removal of diseased immune system, the conventional treatment is invalid in remission, worthy of further exploration.

Details of the article are published in: Chemotherapy. 2008; 54:331; and Chinese Journal of Practical Pediatrics 2007,22 (6): 445

Systemic lupus erythematosus, refractory, treatment, children

Department of Pediatrics, the First Affiliated Hospital of Zhongshan University, Zhongshan two, Guangzhou, China (510080)

 

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