The majority of children with
Juvenile Idiopathic Arthritis can nowadays be treated adequately. However despite the use of combinations of
antirheumatic drugs,
corticosteroids and the newer so called
biologicals (blocking the TNF,
Interleukin 1 or
Interleukin 6 pathways) a proportion of children with
arthritis remain resistant also to these
therapies and suffer from a very severe, debilitating and potentially fatal disease. For such children autologous
stem cell transplantation (ASCT) is successfully performed since 1997. Here we describe the long term outcome of the initial cohort of children with resistant
Juvenile Idiopathic arthritis, treated with ASCT. The initial cohort of children was treated with a conditioning regimen containing
Cyclophosphamide,
anti thymocyte globulins and low dose Total Body irradiation. Overall favourable responses were seen, with a
drug free remission rate of 50-55 %. In the more recent years late relapses were noted with lower percentages for
drug free long term outcome. Special emphasis is given on 2 cases showing very late relapses, occurring after 7 and 9 years. The observed relapses are often less severe compared to the situation before SCT and can be treated successfully with conventional drugs in the majority of cases. More recently, ASCT was performed in 4 JIA children with a fludarabin containing regimen in stead of low dose TBI. With a 4 to 5 year follow up, these 4 patients are all in
drug free full remission. Allogeneic transplant with an HLA matched family donor was reported in 2 JIA cases. Follow up of 1 and 3 year is sofar show clinical disease remission and tapering of medition. In conclusion, given the favourable long term outcome, SCT remains a valuable treatment option for children with
drug resistant JIA.