spbmedicalrecordsНовые Санкт-Петербургские врачебные ведомостиNew St. Petersburg Medical Records1609-2201Первый Санкт-Петербургский государственный медицинский университет имени академика И.П. Павлова10.24884/1609-2201-2024-103-2-11-24spbmedicalrecords-16Research ArticleОБЗОРЫ ЛИТЕРАТУРЫLITERATURE REVIEWSВысокодозная иммуносупрессивная терапия с аутологичной трансплантацией гемопоэтических стволовых клеток при болезни Крона: обзор литературыHigh-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation in Crohn disease: literature reviewhttps://orcid.org/0000-0003-1376-4651ГаничЕ. Г.GanichE. G.

Ганич Екатерина Георгиевна, врач-гастроэнтеролог кабинета ВЗК поликлиники с КДЦ

197022, Санкт-Петербург, ул. Льва Толстого, д. 6–8

Ekaterina G. Ganich, gastroenterologist in the Office of the IBD Polyclinic with the CDC

St. Petersburg

dr.ganich@yandex.ruhttps://orcid.org/0000-0001-8402-0743ЩукинаО. Б.ShchukinaO. B.

Щукина Оксана Борисовна, доктор медицинских наук, профессор кафедры общей врачебной практики (семейной медицины), заведующая кабинетом ВЗК поликлиники с КДЦ

Санкт-Петербург

Oksana B. Shchukina, Dr. of Sci. (Med.), Professor of the Department of General Medical Practice, Head of the Office of the IBD Polyclinic with the CDC

St. Petersburg

burmao@gmail.comhttps://orcid.org/0000-0001-8699-2482ПолушинА. Ю.PolushinA. Yu.

Полушин Алексей Юрьевич, кандидат медицинских наук, врач-невролог, руководитель отделения химиотерапии и трансплантации костного мозга при онкологических и аутоиммунных заболеваниях, заведующий лабораторией нейроонкологии и аутоиммунных заболеваний Научно-исследовательского института детской онкологии, гематологии и трансплантологии имени Р. М. Горбачевой, доцент кафедры неврологии

Санкт-Петербург

Alexey Yu. Polushin, Cand. of Sci. (Med.), Neurologist, Head of the Department of Chemotherapy and Bone Marrow Transplantation for Oncological and Autoimmune Diseases, Head of the Laboratory of Neurooncology and Autoimmune Diseases of the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, Associate Professor of the Department of Neurology

St. Petersburg

alexpolushin@yandex.ruhttps://orcid.org/0000-0002-3881-4486ЗаляловЮ. Р.ZalyalovYu. R.

Залялов Юрий Ринатович, кандидат медицинских наук, врач-гематолог, заведующий блоком химиотерапии и трансплантации костного мозга при онкологических и аутоиммунных заболеваниях

Санкт-Петербург

Yuri R. Zalyalov, Cand. of Sci. (Med.), hematologist, Head of the Chemotherapy and Bone Marrow Transplantation Unit for Oncological and Autoimmune Disease

St. Petersburg

yz21@mail.ruhttps://orcid.org/0000-0002-4544-2967КуликовА. Н.KulikovA. N.

Куликов Александр Николаевич, доктор медицинских наук, профессор, заведующий кафедрой пропедевтики внутренних болезней с клиникой, заведующий кафедрой функциональной диагностики, директор НКИЦ

Санкт-Петербург

Alexander N. Kulikov, Dr. of Sci. (Med.), Professor, Head of the Department of Propaedeutics of Internal Diseases with clinic, Head of the Department of Functional Diagnostics, Director of the SCIC

St. Petersburg

ankulikov2005@yandex.ruhttps://orcid.org/0000-0002-7179-5520ДобронравовВ. А.DobronravovV. A.

Добронравов Владимир Александрович, доктор медицинских наук, профессор кафедры пропедевтики внутренних болезней с клиникой, профессор кафедры нефрологии и диализа ФПО, директор Научно-исследовательского института нефрологии

Санкт-Петербург

Vladimir A. Dobronravov, Dr. of Sci. (Med.), Professor of the Department of Propaedeutics of Internal Diseases with a clinic, Professor of the Department of Nephrology and Dialysis of the Faculty of Postgraduate Studies, Director of the Research Institute of Nephrology

St. Petersburg

dobronravov@nephrolog.ruhttps://orcid.org/0000-0002-9589-4136КулагинА. Д.KulaginA. D.

Кулагин Александр Дмитриевич, доктор медицинских наук, директор Научно-исследовательского института детской онкологии, гематологии и трансплантологии имени Р. М. Горбачевой, заведующий кафедрой гематологии, трансфузиологии и трансплантологии с курсом детской онкологии ФПО им. профессора Б. В. Афанасьева

Санкт-Петербург

Alexander D. Kulagin, Dr. of Sci. (Med.), Professor, Director of the Raisa Gorbacheva Memorial Research Institute for Pediatric Oncology, Hematology and Transplantation, Head of the Department of Hematology, Transfusiology and Transplantology with the course of pediatric Oncology of the of the Faculty of Postgraduate Studies named after Professor B. V. Afanasyev

St. Petersburg

kulagingem@rambler.ruПервый Санкт-Петербургский государственный медицинский университет имени академика И. П. ПавловаРоссияPavlov UniversityRussian Federation202401112024021124Copyright © Ганич Е.Г., Щукина О.Б., Полушин А.Ю., Залялов Ю.Р., Куликов А.Н., Добронравов В.А., Кулагин А.Д., 20242024Ганич Е.Г., Щукина О.Б., Полушин А.Ю., Залялов Ю.Р., Куликов А.Н., Добронравов В.А., Кулагин А.Д.Ganich E.G., Shchukina O.B., Polushin A.Y., Zalyalov Y.R., Kulikov A.N., Dobronravov V.A., Kulagin A.D.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.docved.ru/jour/article/view/16

В литературном обзоре представлено современное положение метода высокодозной иммуносупрессивной терапии с аутологичной трансплантацией стволовых клеток в терапии болезни Крона. В последние десятилетия наблюдается рост заболеваемости болезнью Крона (БК). Частота ответа БК на ГИБТ составляет 20–50%, до 80% пациентов нуждаются в хирургическом лечении. В связи с недостаточной эффективностью терапии ведется активный поиск новых терапевтических возможностей, одной из которых является метод ВИСТ-АТГСК. В РФ имеются данные по использованию мезенхимальных стволовых клеток для лечения БК, исследования по применению ВИСТ-АТГСК при ВЗК отсутствуют. По данным регистра EBMT, в период с 1994 по 2023 гг. было выполнено более 4000 ВИСТ-АТГСК пациентам с аутоиммунными заболеваниями, доля БК составила 6,13% всех протоколов. Процедура ВИСТ- АТГСК состоит из следующих этапов: мобилизации аутологичных ГСК, афереза и криоконсервации ГСК, иммуноаблативного кондиционирования и инфузии ГСК. Большинство публикаций по применению ВИСТ-АТГСК при БК не были универсальными по отбору и ведению пациентов. В настоящее время имеется единственное завершенное РКИ по применению ВИСТ-АТГСК при БК, результаты которого не получили однозначной интерпретации. Однако для когорты пациентов с рефрактерным течением БК необходимо рассмотреть возможность применения данного метода. В обзоре представлены показания и критерии отбора для протокола ВИСТ-АТГСК. Дальнейшие исследования метода ВИСТ-АТГСК при БК помогут расширить терапевтические возможности лечения пациентов, рефрактерных к стандартной и генно-инженерной биологической терапии.

The literature review presents the current status of the method of high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation in the treatment of Crohn’s disease.In recent decades, there has been an increase in Crohn’s disease. The frequency of CD the response rate to biopreparations ranges from 20 to 50%, up to 80% of patients need surgical treatment. Due to the insufficient effectiveness of therapy, an active research is underway for new therapeutic opportunities, one of which is the method of HDIT-AHSCT. In the Russian Federation, there are data on the use of mesenchymal stem cells for the treatment of CD, there are no studies on the use of HDIT-AHSCT in IBD. According to the EBMT register in the period from 1994 to 2023. more than 4000 HDIT-AHSCT were performed in patients with autoimmune diseases, the proportion of CD was 6.13% of all protocols. The HDIT-AHSCT procedure consists of the following stages: mobilization of autologous HSCs, apheresis and cryopreservation of HSCs, immunoablative conditioning and infusion of HSCs. Most of the publications on the use of HDIT-AHSCT in CD were not universal in the selection and management of patients. Currently, there is the only one completed RCT on the use of HDIT-AHSCT in CD, the results of which have not received a definite outcome. However, for a cohort of patients with refractory CD, it is necessary to consider the possibility of using this method. The review presents the indications and selection criteria for the HDIT-AHSCT protocol. Further studies of the HDIT-AHSCT in CD will help expand the therapeutic opportunities of treating patients with refractory CD to standard and biological therapy.

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The authors declare that there are no conflicts of interest present.