Autologous Hematopoietic Stem Cell Transplantation for Treatment of Refractory Rheumatoid Arthritis.
- Author:
Do June MIN
1
;
Chang Ki MIN
;
Dong Won YANG
;
Chong Hyeon YOON
;
Wan Uk KIM
;
Sang Heon LEE
;
Dong Wook KIM
;
Jong Wook LEE
;
Chul Soo CHO
;
Ho Youn KIM
;
Chun Choo KIM
Author Information
1. The Center for Rheumatic Diseases, Catholic University Medical College, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Autologous hematopoietic stem cell transplantation;
Immunoablation;
Rheumatoid arthritis
- MeSH:
Arthritis, Rheumatoid*;
Glycogen Storage Disease Type VI;
Granulocytes;
Hematopoietic Stem Cell Transplantation*;
Hematopoietic Stem Cells*;
Humans;
Immunosuppression;
Neutrophils;
Platelet Count;
Stem Cells
- From:The Journal of the Korean Rheumatism Association
2002;9(1):42-49
- CountryRepublic of Korea
- Language:Korean
-
Abstract:
OBJECTIVE: To investigate the safety and efficacy of immunoablation and subsequent autologous hematopoietic stem cell transplantation (HSCT)in refractory rheumatoid arthritis (RA). METHODS: Three patients with severe,refractory RA were treated.We mobilized autologous hematopoietic stem cells (HSCs)with cyclophosphamide(Cy)and granulocyte colony-stimulating factor.HSCs were collected and enriched ex vivo using CD34-positive immunoselection.Two different immunoablative conditioning regimens were employed; fludarabine-Cy-anti-thymoayte glonulin (ATG)in patients whose disease activity was transiently ameliorated in response to Cy used in stem cell mobilization,or fludarabine-busulfan-ATG in those who didn't show any response to that. RESULTS: Median time to engraftment with an absolute neutrophil count greater than 500/microliter and nontransfused platelet count greater than 20,000/microliter was 15 days (range 12-16)and 9 days (range 7-13),respectively.Regimen-related toxicity was minimal.Two patients were markedly improved at 2 or 3 months after HSCT,repectively.In another patient,disease activity was transiently subsided,but relapsed at 2 months after HSCT,which led to reinstitution of anti-rheumatic medications.This resulted in subsequent marked improvement of disease activity whereas her disease had been refractory to these medications. CONCLUSIONS: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of refractory rheumatoid arthritis.The durability of remission remains to be clarified.
