A Preliminary Result Of Treatment Of Myasthenia Gravis With Autologous Peripheral Blood Stem Cell Transplantation In China

Objective: To explore the clinical effect of autologous peripheral blood stem cell transplantation (APBSCT) on myasthenia gravis (MG). Methods: Three MG patients were chosen. Autologous peripheral blood stem cells (APBSCs) were mobilized with cyclophosphamide (CTX) and granulocyte colony-stimulating factor (G-CSF). The CD34+ cells harvesting was performed by continuous flow leukapheresis using a CS-3000 plus blood separator, then APBSCs were collected and preserved at 4℃ in refrigerator before patients were conditioned by CTX (60mg/kg/d, for 2 days) + maphalan(120mg/m2/d, for 1 day) + thymus radiotherapy + plasma exchange.To clear away T cell, antilymphocyte globulin was used (10mg/kg/d, for 2 days ) after APBSCs had been reinfused. Granulocyte recovery was stimulated by G-CSF. The three patients' clinical manifestations and immunologic markers were compared before and after transplantation.Results: An excellent clinical remission was observed after transplantation in 2～8 months,and there was no replapse. The examination results of the T cells subgroup, immunoglobulin and complement were also improved obviously. The muscle that decreased most in the repetitive nerve stimulation test before transplantation was the one that improved latest after transplantation.Conclusions: APBSCT is effective and safe for MG, but the long-term effect should be followed up. The repetitive nerve stimulation test before transplantation is helpful in predicting the recovery of MG after APBSCT to some extent.