Evaluation of the efficacy of autologous hematopoietic stem cell transplantation combined with intermittent low dose cyclophosphamide in the treatment of severe lupus nephritis

Objective To evaluate the efficacy of autologous hemopoietic stem cell transplantation(ASCT) combined with intermittent low-dose cyclophosphamide in the treatment of severe lupus nephritis and its effect on serum anti-dsDNA antibody, PBMC protein carbonyl concentration and Fas expression rate. Methods 120 patients with severe lupus nephritis admitted to the Fifth Hospital of Xi'an from January 2016 to January 2018 were randomly divided into observation group and control group; the control group was treated with ASCT method, and the observation group was treated with ASCT method combined with intermittent small dose. Cyclophosphamide treatment; systemic lupus erythematosus disease activity index(SLEDAI) was collected before treatment and 6 months after treatment, and the number of erythrocytes, urine protein and albumin in urine were detected in the two groups, platelets, anti-U1 ribonucleoprotein(U1RNP) antibody, complement C3, peripheral blood CD4⁺T, CD8⁺T, CD4⁺/CD8⁺ ratio, regulatory T cell(Treg), and CD20⁺ B cell percentage, dsDNA antibody, PBMC protein carbonyl concentration, T cell Fas expression rate, B cell Fas expression rate and T, B lymphocyte apoptosis rate. Results After treatment, the SLEDAI score of the observation group was significantly lower than that of the control group(P<0.05), the number of urinary red blood cells, urine protein level, serum dsDNA antibody, serum PBMC protein carbonyl concentration, Fas expression rate of T cells and B cells, T cells and The apoptosis rate of B cells was significantly lower than that of the control group(P<0.05). The levels of serum albumin, platelet, C3, CD4⁺, CD8⁺, CD4⁺/CD8⁺, Treg and CD20⁺ B cells in the observation group were significantly higher than those in the control group(P<0.05).The positive rate of U1RNP in the observation group was significantly lower than that in the control group(P<0.05). Conclusions The use of ASCT combined with intermittent low-dose cyclophosphamide in the treatment of severe lupus nephritis can effectively improve the clinical efficacy, and reduce serum anti-dsDNA antibody, PBMC protein carbonyl concentration level and Fas expression rate.