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Autologous stem cell transplantation in the treatment of refractory rheumatoid arthritis.

By Ki Chan Kim, In Hong Lee, Jung Hye Choi, Mee Ran Oh, Myung Ju Ahn and Seong Yoon Kim

Abstract

The concept of using high-dose immunosuppressive treatment (HDIT) with autologous stem cell transplantation (ASCT) to treat patients with refractory rheumatoid arthritis has been provided by animal studies and anecdotal case reports. Over the past five years, an increasing number of patients with refractory rheumatoid arthritis have received HDIT with ASCT as an adjunct to intense immunosuppression. Here, we present a case of refractory rheumatoid arthritis in a 54-yr-old woman using HDIT with ASCT. Peripheral blood stem cells were mobilized with cyclophosphamide (4 g/m(2)) followed by G-CSF (5 microg/kg/day). Leukapheresis continued daily until the number of harvested progenitor cells reached 2 x 10(6) CD34+ cells/kg after CliniMax CD34+ positive selection. For HDIT, high-dose cyclophosphamide (total dose 200 mg/kg) and antithymocyte globulin (total dose 90 mg/kg) were administered and CD34+ cells were infused 24 hr after HDIT. The patient tolerated the treatment well but experienced an episode of neutropenic fever. She achieved an early dramatic improvement of joint symptoms during therapy. Fifty percent of improvement of rheumatoid arthritis by the American College of Rheumatology (ACR 50) preliminary definition was fulfilled during the 6 months following ASCT. Although further long-term follow-up is required, the patient's activity of arthritis has been stable since receiving HDIT with ASCT

Topics: Research Article
Publisher: Korean Academy of Medical Sciences
OAI identifier: oai:pubmedcentral.nih.gov:3054838
Provided by: PubMed Central

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Citations

  1. (1999). A phase I/II dose escalation study of intensified cyclophosphamide and autologous blood stem cell rescue in severe, active rheumatoid arthritis. Arthritis Rheum
  2. (1995). American College of Rheumatology preliminary definition of improvement in rheumatoid arthritis. Arthritis Rheum
  3. (1996). Autologous blood stem cell transplantation for autoimmune diseases. Lancet
  4. (1997). Autologous bone marrow transplantation for rheumatoid arthritis. Lancet
  5. (1999). Autologous hematopoietic stem cell transplantation in refractory rheumatoid arthritis. Arthritis Rheum
  6. (1997). Autologous hemopoietic stem cell transplantation: A possible cure for rheumatoid arthritis? Arthritis Rheum
  7. (1997). Blood and marrow stem cell transplants in autoimmune disease: A concensus report written on behalf of the European League Against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant
  8. (1997). Choosing appropriate patients with SSc for132
  9. (1982). Demonstration of bone marrow derived cells in synovial lining by means of giant intracellular granules as genetic markers. Ann Rheum Dis
  10. (1996). Early recurrence or persistence of immune diseases after unmanipulated autologous stem cell transplantation. Blood
  11. (1997). Hematopoietic stem cell transplantation for autoimmune diseases.
  12. (1995). Kwoh CK. Effects of cyclophosphamide on the development of malignancy and on longterm survival of patients with rheumatoid arthritis. A 20-yr followup study. Arthritis Rheum
  13. (1994). Local proliferation of fibroblast-like synoviocytes contributes to synovial hyperplasia: Results of proliferating cell nuclear antigen/ cyclin, c-myc, and nuclear organizer region staining. Arthritis Rheum
  14. (1998). Long-term outcome of autoimmune disease following allogeneic bone marrow transplantation. Arthritis Rheum
  15. (1999). Mixed chimerism: Preclinical studies and clinical applications.
  16. (1998). Psychometric evaluation of a Korean Health Assessment Questionnaire for clinical research.
  17. (1998). Remission and immune reconstitution after T-cell-depleted stem-cell transplantation for rheumatoid arthritis. Lancet
  18. (1993). Rheumatoid arthritis: opposing actions of hematopoietic growth factors and slow-acting anti-rheumatic drugs. Lancet
  19. (1999). Secondary leukemia and myelodysplasia after autografting for lymphoma: results from the EBMT. EBMT Lymphoma and Late Effects Working Parties. European Group for Blood and Marrow Transplantation. Br J Haematol
  20. Stem cell transplantation in auto-immune disease-plenary lecture APLAR.
  21. (1997). The evolving role of blood and marrow transplantation for the treatment of autoimmune diseases.
  22. (1997). The potential role of autologous stem cell transplantation in patients with systemic lupus erythematosus.
  23. Treatment of refractory rheumatoid arthritis utilizing an outpatient autologous blood stem cell transplantation protocol. Blood 1998; 92(suppl 1):