Intensive immunoablation and autologous blood stem cell transplantation in patients with refractory rheumatoid arthritis: The University of Nebraska experience

S. Z. Pavletic, James Robert O'Dell, Samuel Jay Pirruccello, M. M. Ursick, C. E. Haire, John G Sharp, A. Kessinger, Lynell Warren Klassen

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23 Citations (Scopus)

Abstract

Two patients with severe rheumatoid arthritis (RA) were treated with high dose chemotherapy and autologous blood stem cell transplantation. Hematopoietic stem cells mobilized readily with cyclophosphamide and granulocyte-colony stimulating factor. Both patients achieved an American College of Rheumatology (ACR) 50% response before starting high dose therapy. The transplantation regimen included 200 mg/kg cyclophosphamide and 6 doses of equine antithymocyte globulin. Transplantation was well tolerated and both patients recovered neutrophils on day 7 post-transplant. At one month post-transplant both patients had an ACR response of 80%. Both individuals relapsed at 6 months and responded well to a combination of disease modifying antirheumatic drugs that was previously ineffective. At 12 months ACR responses were 80% and 60%, respectively. The first patient developed a flare at 18 months when she was found to be hypothyroid; she regained an 80% ACR response at 24 months with therapy of hypothyroidism. The second patient progressed relentlessly 15 months post-transplant. Immunological reconstitution showed a continuous inversion of the ratio of CD4 and CD8 lymphocytes with a predominant expansion of memory T cells.

Original languageEnglish (US)
Pages (from-to)13-20
Number of pages8
JournalJournal of Rheumatology
Volume28
Issue numberSUPPL. 64
StatePublished - Jan 1 2001

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Stem Cell Transplantation
Blood Cells
Rheumatoid Arthritis
Rheumatology
Transplants
Cyclophosphamide
Transplantation
CD4-CD8 Ratio
Antirheumatic Agents
Antilymphocyte Serum
Granulocyte Colony-Stimulating Factor
Hematopoietic Stem Cells
Hypothyroidism
Horses
Neutrophils
Lymphocytes
T-Lymphocytes
Drug Therapy
Therapeutics

Keywords

  • Hematopoietic stem cell transplantation
  • Immunological reconstitution
  • Rheumatoid arthritis

ASJC Scopus subject areas

  • Rheumatology
  • Immunology and Allergy
  • Immunology

Cite this

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abstract = "Two patients with severe rheumatoid arthritis (RA) were treated with high dose chemotherapy and autologous blood stem cell transplantation. Hematopoietic stem cells mobilized readily with cyclophosphamide and granulocyte-colony stimulating factor. Both patients achieved an American College of Rheumatology (ACR) 50{\%} response before starting high dose therapy. The transplantation regimen included 200 mg/kg cyclophosphamide and 6 doses of equine antithymocyte globulin. Transplantation was well tolerated and both patients recovered neutrophils on day 7 post-transplant. At one month post-transplant both patients had an ACR response of 80{\%}. Both individuals relapsed at 6 months and responded well to a combination of disease modifying antirheumatic drugs that was previously ineffective. At 12 months ACR responses were 80{\%} and 60{\%}, respectively. The first patient developed a flare at 18 months when she was found to be hypothyroid; she regained an 80{\%} ACR response at 24 months with therapy of hypothyroidism. The second patient progressed relentlessly 15 months post-transplant. Immunological reconstitution showed a continuous inversion of the ratio of CD4 and CD8 lymphocytes with a predominant expansion of memory T cells.",
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AU - Ursick, M. M.

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