Abstract:

Abstract Objective: To observe the change of lymphocyte subsets in patients with severe lupus nephritis (LN) after the autologous hematopoietic stem cell transplantation (ASCT) and the relationship with clinical curative effect. Methodology: Eighteen patients with severe and refractory LN who underwent ASCT from June 2011 to June 2014 were investigated retrospectively, whose clinical manifestations persisted or recurred frequently after immunosuppressive therapy. Cyclophosphamide（CTX）and granulocyte colony-stimulating factor（G-CSF）were used before stem cell harvest, and the conditioning regimens included CTX and anti-thymocyte globulin（ATG）. The therapeutic effect of ASCT on LN, as well as changes in CD4+ T cells, CD8+ T cells, CD4+CD25+ regulatory T cells (CD4+CD25+ Treg) and CD20+B cells were analyzed. Results: After ASCT, the patients’ SLE disease activity index (SLE-DAI), urine protein excretion, as well as autoantibody positive rate was decreased significantly, while the levels of serum albumin, C3 and C4 were increased notably. The counts of CD4+ T cell and CD8+ T cell were decreased after stem cell harvest, and then increased after transfusion. More CD4+T cells were found at 12 months、18 months after transfusion compared with before harvest, and more CD8+T cells were found every time point after transfusion compared with before harvest. The inversion of the CD4+/CD8+ ratio persisted. The counts of CD4+CD25+Treg were increased notably after the treatment. The variation trend of CD20+B cells was the same as CD4+T cells and CD8+T cells. Conclusion: ASCT is an effective therapy to severe and refractory LN, but the imbalance of lymphocyte subsets persists. The increase of CD4+CD25+Treg counts may play an important role in the treatment. 6 months after transfusion, the number of CD20+B cells were increased, as well as the positive rate of autoantibodies. This suggests that it may be necessary to give immunosuppressive therapy at that time.

Key words:  lupus nephritis, autologous hematopoietic stem cell transplantation, lymphocyte subsets