Intense immunosuppressive therapy followed by autologous peripheral blood selected progenitor cell reinfusion for severe autoimmune disease.

Abstract

Autologous stem cell transplantation (HSCT) has been shown to be effective in curing a large spectrum of autoimmune disorders. Case reports are being collected in the EBMT/EULAR Autoimmune Disease Stem Cell Project registry, which reports transplant-related mortality (TRM) of 6%. In order to reduce TRM and preserve the anti-autoimmune effect we evaluated a more immunoablative as opposed to myeloablative conditioning regimen for the autotransplant of severe immunomediated diseases. We enrolled patients affected by systemic lupus erythematosus (SLE: 3 patients), by autoimmune thrombocytopenic purpura (AITP: one patient), by thrombotic thrombocytopenic purpura (TTP: one patient), by pure red cell aplasia (PRCA: one patient), and by a severe cryoglobulinemia (one patient). All patients were mobilized with cyclophosphamide (Cy) 4 g/m2 + G-csf. Conditioning regimen consisted of Cy 50 mg/kg/day (days -6 and -5); anti-T-globulin (ATG) 10 mg/kg/day and 6-methylprednisolone (PDN) 1 g/day (days -4, -3, and -2). Immunomagnetically selected CD34+ cells were re-infused on day 0. In three patients neutrophil count fell below 0.5 x 10(9)/l, while a PLT count below 20 x 10(9)/l was registered in two patients. Extrahematological toxicity was very low. Four patients (2 SLE, 1 TTP, 1 cryoglobulinemia) are in complete corticosteroid-free remission with a median follow up of 335 days. The third SLE patient improved considerably; however, he still needs low-dose corticosteroid maintenance. The AITP and PRCA patients achieved a CR but soon relapsed; nevertheless, the procedure restored a steroid-sensitive status. The use of this immunoablative conditioning regimen in auto-HSCT transplant was shown to be effective in controlling disease progression and could be a valuable strategy in reducing TRM.

• Authors: M Musso, F Porretto, A Crescimanno, F Bondi, V Polizzi, R Scalone
• Journal: American journal of hematology (Am J Hematol) Vol. 66 Issue 2 Pg. 75-9 (Feb 2001) ISSN: 0361-8609 [Print] United States
• PMID: 11421302 (Publication Type: Journal Article)

Chemical References

• Antigens, CD34
• Antilymphocyte Serum
• Immunosuppressive Agents
• Cyclophosphamide
• Methylprednisolone

Topics

• Adolescent
• Adult
• Aftercare
• Antigens, CD34 (analysis)
• Antilymphocyte Serum (administration & dosage, toxicity)
• Autoimmune Diseases (complications, therapy)
• Cyclophosphamide (administration & dosage, toxicity)
• Female
• Follow-Up Studies
• Hematopoietic Stem Cell Transplantation (methods)
• Hospitalization
• Humans
• Immunomagnetic Separation
• Immunosuppressive Agents (administration & dosage, therapeutic use)
• Male
• Methylprednisolone (administration & dosage, toxicity)
• Middle Aged
• Transplantation Conditioning (adverse effects, methods, standards)
• Transplantation, Autologous (adverse effects, methods, standards)
• Treatment Outcome