J Korean Rheum Assoc.
2002 Mar;9(1):42-49.
Autologous Hematopoietic Stem Cell Transplantation for Treatment of Refractory Rheumatoid Arthritis
- Affiliations
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- 1The Center for Rheumatic Diseases, Catholic University Medical College, Seoul, Korea.
- 2Catholic Hemopoietic Stem Cell Transplatation Center, Catholic University Medical College, Seoul, Korea.
- 3Department of Neurology, Catholic University Medical College, Seoul, Korea.
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.
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