Bone marrow transplantation brings hope to some patients with hematological disease. However, slow graft versus host disease is a serious fatal complication after bone marrow transplantation. The current lack of safe and reliable treatment of drugs.
Navy General Hospital hematology Qian Li Ren attending physician in recent years to carry out hydrogen on this serious complications of clinical research, initially achieved satisfactory results, to the treatment of this disease has brought new hope.
China’s hydrogen medical research scale is very large, there are already some hospitals to carry out the clinical study of hydrogen, but the formal clinical reports are still relatively small.
Qian Li Ren doctor graduate student graduated from the Second Military Medical University Department of Naval Medicine, is the international relatively early in the study of hydrogen medicine scholars, and now focus on efforts to clinical use of hydrogen, commendable.
Author: PLA Navy General Hospital Qian Li Ren
In World War II in 1945, Japan’s Hiroshima, Nagasaki suffered a large number of nuclear radiation victims after the atomic explosion.
Radiation damage is mainly related to hematopoietic and immune system, but also to promote the birth of this treatment of bone marrow transplantation.
In 1945, Jacobson and other reports of mice exposed to bone marrow cells can survive, in 1951 Lorenz and other evidence to the mice after exposure to the same kind of bone marrow can survive the same, in 1959, our scholars confirmed the results of the study.
In 1977, the United States Professor Donnelly Thomas and other reports using bone marrow transplantation for the treatment of 100 patients with advanced leukemia, leukemia patients greatly extended the survival period, since opening up a new era of bone marrow transplantation.
The birth of bone marrow transplantation makes it possible to cure many benign and malignant diseases of the blood system, such as leukemia, myeloma, lymphoma, aplastic anemia, and so on, so that the world’s trillions of patients with hematological diseases benefit.
Thomas received the 1990 Nobel Prize in Medicine or Physiology for Cell Transplantation and became “the father of bone marrow transplantation.” At present, this treatment has been known.
Bone marrow transplantation using donor-derived cells mainly include bone marrow, peripheral blood stem cells, umbilical cord blood stem cells, etc., is the hematopoietic stem cells and immunocompetent cells simultaneously implanted into the recipient, to take the hematopoietic and immune function.In the allogeneic bone marrow transplantation after the immune function in addition to restore the external immune response, while the recipient’s own cells to respond, that is, graft-versus-host disease (GVHD), that is, we often say rejection.Traditionally, the rejection response within 100 days is called acute rejection, and the rejection after 100 days is called chronic rejection.In the early stage of bone marrow transplantation, the mortality rate of acute rejection is very high. With the development of medicine and the emergence of various new drugs, the cure rate of acute rejection has been greatly improved.But chronic rejection is currently no ideal treatment. However, with the increase in the use of allogeneic bone marrow transplantation in elderly patients, peripheral blood stem cells as a wide range of graft applications and increased survival after transplantation, the incidence of chronic rejection is increasing year by year. In the past 10 years, chronic rejection has become the most difficult complication of allogeneic hematopoietic stem cell transplantation, and has become the leading cause of non-transplant-related death after transplantation.
Over the past three decades, the first-line treatment of chronic rejection has been largely dependent on glucocorticoids (such as prednisone, methylprednisolone, dexamethasone, etc.).Clinically, the initial treatment of chronic rejection often uses prednisone or no combination of cyclosporine or tacrolimus.The starting dose of prednisone is usually 0.5-1mg / kg / day, after the disease control gradually reduced.In the process of glucocorticoid reduction, patients with chronic rejection of the symptoms tend to increase or even relapse, resulting in the reduction of glucocorticoid or even increase the amount.In clinical practice, the use of glucocorticoid treatment of chronic rejection of treatment is often reached 3 months, or even longer.However, long-term use of glucocorticoids can lead to serious side effects, including severe infections, peptic ulcers, femoral head necrosis, osteoporosis, weight gain, diabetes, high blood pressure, emotional instability, cataracts and so on.In order to minimize the side effects of long-term use of glucocorticoids, clinicians often use glucocorticoids in combination with other immunosuppressive agents to treat chronic rejection, including calcineurin inhibitors (such as cyclosporine, tacrolimus ), Azathioprine, mycophenolate mofetil, hydroxychloroquine, and the like. And long-term use of these immunosuppressive agents on the various organs of patients with higher requirements, long-term use will also lead to higher toxic side effects.
Navy General Hospital Department of Hematology Qian Li Ren attending physician and others from the beginning of 2012 to carry out hydrogen on bone marrow transplantation after the treatment of the role of rejection, has carried out basic and clinical trials, the results of previous animal experiments in the transplant field authoritative magazine “Transplantation (2013: 95, 658-662) and “Journal of Cellular and Molecular Medicine” (2013: 17,1059-1063).
Recently, the team reported on the “Medical Gas Research” a case of successful use of hydrogen treatment of a case of severe chronic rejection of the clinical case.
This patient is a 54-year-old male patients with myelodysplastic syndrome, bone marrow transplantation after 3 years, a clear diagnosis of severe chronic GVHD, lesions involving a wide range of skin, mouth, eyes, intestines, liver, lungs, joints and other parts, The use of prednisone and tacrolimus after treatment is not controlled, the daily reference to hydrogen-rich water after the symptoms gradually improved, and the hormone and tacrolimus gradually reduced.
In the use of hydrogen after 3 months of treatment of various organs of the function was significantly improved in the treatment after 6 months only in the skin and eyes there are some lesions, and achieved good therapeutic effect.
The team can also be found at the International Clinical Trials Registry clinicaltrials.gov also registered a clinical trial of hydrogen on refractory recurrent chronic GVHD ClinicalTrials.govIdentifier: NCT02918188. Perhaps the hydrogen is worth more than allogeneic bone marrow transplant after chronic rejection of the patient’s attempt.
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