Control of severe systemic lupus erythematosus after high-dose immunusuppressive therapy and transplantation of CD34+ purified autologous stem cells from peripheral blood

Abstract

A 35 y old woman with severe and progressive systemic lupus erythematosus (SLE) received highdose chemotherapy followed by a T cell depleted autologous stem cell transplantation. Peripheral blood stem cell were mobilised with Cyclophosphamide 4.5 g/m² followed by Granulocyte-Colony Stimulating Factor (G-CSF). A CD34 positive selection provided a 3 log T cell depletion. High-dose immunosuppression consisted of the BEAM regimen. The purified autograft was reinfused on day 0. In the post transplant period, hemopoietic growth factors, G-CSF, Granulocyte-Macrophage Colony Stimulating Factor (GM-CSF) and Erythropoietin, were administered, engraftment was rapid. Both the mobilisation and the transplant procedures were easily performed and well tolerated. One year later, the patient is in clinical remission. The ANA and anti-SSA-antibodies were undetectable at 1 and 6 months after intensification, but reappeared at low levels at 9 months. Corticosteroid requirement has gradually decreased. In conclusion, we report here the favourable evolution of a patient with a severe SLE, who clinically improved with high-dose immunosuppressive therapy and autologous stem cell transplantation, and showed a 9 month serological remission.

Keywords

severe systemic lupus erythematosus autologous stem cell transplantation

Get full access to this article

View all access options for this article.

References

Ikehara S . Bone marrow transplantation for autoimmune diseases . Acta Haematol 1998; 99: 116–132 .

Marmont AM . Perspective immune ablation with stem-cell rescue: a possible cure for systemic lupus erythematosus? Lupus 1993; 2: 151–156 .

Euler HH , Marmoud AM , Baugalupo A et al. Early recurrence of persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation . Blood 1996; 88: 3621–3625 .

Tyndall A , Gratwohl A . Blood and marrow stem cell transplants in autoimmune disease: a consensus report written on behalf of the European League Against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT) . Br J Rheumatol 1997; 36: 390–392 .

Marmont AM , Van Lint MT , Gualandi F , Bacigalupo A . Case report: Autologous marrow stem cell transplantation for severe systemic lupus erythematosus of long duration . Lupus 1997, 6: 545–548 .

Burt RK , Traynor A , Pope R et al. Treatment of autoimmune disease by intense immunosuppressive conditioning and autologous hematopoietic stem cell transplantation . Blood 1998; 92: 3505–3514 .

Marmont AM . New horizons in the treatment of autoimmune disease: stem cell transplantation. Ann Rev Med in press.

Snowden JA , Biggs JC , Milliker ST et al. A randomised, blinded, placebo-controlled, dose escalation study of the tolerability and efficacy of filgrastim for haemopoietic stem cell mobilisation in patients with severe active rheumatoid arthritis . Bone Marrow Trans 1998; 22: 1035–1041 .