Immunoablative high-dose cyclophosphamide without stem-cell rescue for refractory, severe autoimmune disease.

Abstract

BACKGROUND:

Immunoablative high-dose cyclophosphamide without stem-cell rescue induces durable, complete remission in most patients with aplastic anemia.

OBJECTIVE:

To determine the efficacy of high-dose cyclophosphamide in various refractory, severe autoimmune diseases.

DESIGN:

Prospective phase II study.

SETTING:

Johns Hopkins University (Baltimore, Maryland) and Hahnemann University (Philadelphia, Pennsylvania).

PATIENTS:

Eight patients with refractory, severe autoimmune disease.

INTERVENTION:

Immunoablative high-dose cyclophosphamide (50 mg/kg of body weight per day) for 4 consecutive days.

MEASUREMENTS:

Clinical and laboratory variables of autoimmune disease.

RESULTS:

Seven patients improved markedly: Five achieved complete remission and two achieved partial remission. Four patients have remained in continuous complete remission for 3 to 21 months, and two patients in partial remission continue to improve after 14 and 19 months of follow-up. High-dose cyclophosphamide was well tolerated; median times to a neutrophil count of 0.5 x 10(9) cells/L and platelet transfusion independence were 17 and 16 days, respectively.

CONCLUSIONS:

Immunoablative high-dose cyclophosphamide without stem-cell rescue can induce complete remission in patients with refractory, severe autoimmune disease. Reemergence of marrow function is similar to that seen after autologous transplantation and does not carry the risk for reinfusion of autoaggressive lymphocytes with the autograft.

• Authors: R A Brodsky, M Petri, B D Smith, E J Seifter, J L Spivak, M Styler, C V Dang, I Brodsky, R J Jones
• Journal: Annals of internal medicine (Ann Intern Med) Vol. 129 Issue 12 Pg. 1031-5 (Dec 15 1998) ISSN: 0003-4819 [Print] United States
• PMID: 9867758 (Publication Type: Case Reports, Clinical Trial, Clinical Trial, Phase II, Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't, Research Support, U.S. Gov't, P.H.S.)

Chemical References

• Immunosuppressive Agents
• Cyclophosphamide

Topics

• Adult
• Autoimmune Diseases (drug therapy)
• Cyclophosphamide (administration & dosage)
• Drug Administration Schedule
• Female
• Humans
• Immunosuppressive Agents (administration & dosage)
• Male
• Middle Aged
• Prospective Studies
• Remission Induction
• Treatment Outcome