Stem Cell Treatment for Rheumatoid Arthritis
Posted on 12/20/2011
High Dose Chemotherapy and Autologous Hematopoietic Stem Cell Transplantation for Rheumatoid Arthritis: A Review
ABSTRACT
A new treatment approach, involving intense immunosuppression and autologous hematopoietic stem cell transplantation (SCT), has emerged in recent years for the treatment of severe, refractory rheumatic autoimmune diseases including rheumatoid arthritis (RA). The rationale of this strategy is based on the concept of immunoablation by intense immunosuppression with subsequent regeneration of native T lymphocytes derived from reinfused hematopoietic progenitor cells. Patients with a therapy-refractory, progressively erosive disease who are at risk of functional disability and early mortality are considered eligible for treatment with autologous SCT. The goal is long-term improvement of disease activity and quality of life. However, when offering SCT to RA patients these benefits should be balanced against toxicities and treatment-related mortality. In several patients with intractable RA, long-term remissions were observed with this strategy, but failures have been reported as well. Only small numbers of RA patients have been treated thus far. Although different treatment protocols have been used, high dose chemotherapy as a means to achieve immunoablation has been in variably used in all studies. In this review we discuss background, clinical results, protocols, and future prospects of high dose chemotherapy and autologous SCT for RA.
KEYWORDS: Hematopoietic stem cell transplantation; rheumatoid arthritis; chemotherapy
Robert J. Verburg, Rene´ E. M. Toes, Willem E. Fibbe, Ferdinand C. Breedveld, and Jacob M. van Laar
Human Immunology 63, 627–637 (2002) © American Society for Histocompatibility and Immunogenetics, 2002 Published by Elsevier Science Inc.
