Autologous peripheral blood stem cell transplantation with in vivo T-cell depletion for life threatening refractory systemic lupus erythematosus
Identifieur interne : 001E99 ( Main/Exploration ); précédent : 001E98; suivant : 001F00Autologous peripheral blood stem cell transplantation with in vivo T-cell depletion for life threatening refractory systemic lupus erythematosus
Auteurs : D. Talaulikar [Australie] ; K E Tymms ; I. Prosser [Australie] ; R. Smith [Australie]Source :
- Lupus [ 0961-2033 ] ; 2005-02.
English descriptors
- Teeft :
- Active arthritis, Adequate collection, Airway, Airway obstruction, Arthritis, Arthritis rheum, Autoimmune, Autoimmune disease, Autoimmune diseases, Autologous, Autologous transplant, Bromocriptine therapy, Canberra hospital, Cell graft, Cell mobilization, Cell rescue, Cell transplant, Cell transplantation, Conventional therapy, Cutaneous vasculitis, Cyclophosphamide, Disease activity, Erythematosus, European group, Further dose, Graft, Haemopoietic, High dose cyclophosphamide, Hsct, Intravenous cyclophosphamide, Lupus, Lupus erythematosus, Mycophenolate mofetil, Obstruction, Organ disease, Peripheral blood, Pituitary microadenoma, Platelet, Platelet count, Prednisolone, Severe lupus erythematosus, Sledai, Sledai score, Sledai scores, Steroid therapy, Systemic lupus erythematosus, Systemic lupus erythematosus disease activity index, Transplant, Transplantation, Unmanipulated, Unmanipulated graft, Upper airway obstruction, Vivo depletion, Vivo lymphocyte depletion.
Abstract
We report the first Australian application of autologous haemopoietic stem cell transplantation in a 39-year old woman with severe systemic lupus erythematosus (SLE) and multiple life threatening complications, refractory to conventional therapy including intravenous cyclophosphamide. Our transplant technique, although not unique, differs from most published reports, in which an unmanipulated peripheral stem cell graft was used with in vivo lymphocyte depletion using rabbit antithymocyte globulin (ATG). Successful stem cell mobilization was achieved using granulocyte-colony stimulating factor mobilization with methylprednisolone cover, after an initial attempt at mobilization was curtailed by respiratory arrest from upper airway obstruction due to cricoarytenoiditis, requiring tracheostomy. Conditioning regimen for the transplantation was cyclophosphamide 50 mg/kg on days 25to 22 and rabbit ATG 2.2 mg/kg on days 23 and 22. An unmanipulated autograft was infused, with in vivo T-cell depletion achieved through a further dose of ATG given on day +2 postinfusion. The autologous transplant was well tolerated without fever or other serious complication. At 12 months follow-up post-transplantation, there is an objective evidence of near-complete response with SLE disease activity index scores falling from 40 pretransplant to 2. We conclude that HSCT with unmanipulated peripheral stem cell graft and in vivo lymphocyte depletion with ATG is safe and effective therapy for cyclophosphamide refractory SLE.
Url:
DOI: 10.1191/0961203305lu2041cr
Affiliations:
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Smith</name><affiliation wicri:level="1"><country xml:lang="fr">Australie</country><wicri:regionArea>Department of Rheumatology, The Canberra Hospital</wicri:regionArea><wicri:noRegion>The Canberra Hospital</wicri:noRegion></affiliation></author></analytic><monogr></monogr><series><title level="j">Lupus</title><idno type="ISSN">0961-2033</idno><idno type="eISSN">1477-0962</idno><imprint><publisher>Sage Publications</publisher><pubPlace>Sage CA: Thousand Oaks, CA</pubPlace><date type="published" when="2005-02">2005-02</date><biblScope unit="volume">14</biblScope><biblScope unit="issue">2</biblScope><biblScope unit="page" from="159">159</biblScope><biblScope unit="page" to="163">163</biblScope></imprint><idno type="ISSN">0961-2033</idno></series></biblStruct></sourceDesc><seriesStmt><idno type="ISSN">0961-2033</idno></seriesStmt></fileDesc><profileDesc><textClass><keywords scheme="Teeft" xml:lang="en"><term>Active arthritis</term><term>Adequate collection</term><term>Airway</term><term>Airway obstruction</term><term>Arthritis</term><term>Arthritis rheum</term><term>Autoimmune</term><term>Autoimmune disease</term><term>Autoimmune diseases</term><term>Autologous</term><term>Autologous transplant</term><term>Bromocriptine therapy</term><term>Canberra hospital</term><term>Cell graft</term><term>Cell mobilization</term><term>Cell rescue</term><term>Cell transplant</term><term>Cell transplantation</term><term>Conventional therapy</term><term>Cutaneous vasculitis</term><term>Cyclophosphamide</term><term>Disease activity</term><term>Erythematosus</term><term>European group</term><term>Further dose</term><term>Graft</term><term>Haemopoietic</term><term>High dose cyclophosphamide</term><term>Hsct</term><term>Intravenous cyclophosphamide</term><term>Lupus</term><term>Lupus erythematosus</term><term>Mycophenolate mofetil</term><term>Obstruction</term><term>Organ disease</term><term>Peripheral blood</term><term>Pituitary microadenoma</term><term>Platelet</term><term>Platelet count</term><term>Prednisolone</term><term>Severe lupus erythematosus</term><term>Sledai</term><term>Sledai score</term><term>Sledai scores</term><term>Steroid therapy</term><term>Systemic lupus erythematosus</term><term>Systemic lupus erythematosus disease activity index</term><term>Transplant</term><term>Transplantation</term><term>Unmanipulated</term><term>Unmanipulated graft</term><term>Upper airway obstruction</term><term>Vivo depletion</term><term>Vivo lymphocyte depletion</term></keywords></textClass><langUsage><language ident="en">en</language></langUsage></profileDesc></teiHeader><front><div type="abstract" xml:lang="en">We report the first Australian application of autologous haemopoietic stem cell transplantation in a 39-year old woman with severe systemic lupus erythematosus (SLE) and multiple life threatening complications, refractory to conventional therapy including intravenous cyclophosphamide. Our transplant technique, although not unique, differs from most published reports, in which an unmanipulated peripheral stem cell graft was used with in vivo lymphocyte depletion using rabbit antithymocyte globulin (ATG). Successful stem cell mobilization was achieved using granulocyte-colony stimulating factor mobilization with methylprednisolone cover, after an initial attempt at mobilization was curtailed by respiratory arrest from upper airway obstruction due to cricoarytenoiditis, requiring tracheostomy. Conditioning regimen for the transplantation was cyclophosphamide 50 mg/kg on days 25to 22 and rabbit ATG 2.2 mg/kg on days 23 and 22. An unmanipulated autograft was infused, with in vivo T-cell depletion achieved through a further dose of ATG given on day +2 postinfusion. The autologous transplant was well tolerated without fever or other serious complication. At 12 months follow-up post-transplantation, there is an objective evidence of near-complete response with SLE disease activity index scores falling from 40 pretransplant to 2. We conclude that HSCT with unmanipulated peripheral stem cell graft and in vivo lymphocyte depletion with ATG is safe and effective therapy for cyclophosphamide refractory SLE.</div></front></TEI><affiliations><list><country><li>Australie</li></country></list><tree><noCountry><name sortKey="Tymms, K E" sort="Tymms, K E" uniqKey="Tymms K" first="K E" last="Tymms">K E Tymms</name></noCountry><country name="Australie"><noRegion><name sortKey="Talaulikar, D" sort="Talaulikar, D" uniqKey="Talaulikar D" first="D" last="Talaulikar">D. Talaulikar</name></noRegion><name sortKey="Prosser, I" sort="Prosser, I" uniqKey="Prosser I" first="I" last="Prosser">I. Prosser</name><name sortKey="Smith, R" sort="Smith, R" uniqKey="Smith R" first="R" last="Smith">R. Smith</name></country></tree></affiliations></record>Pour manipuler ce document sous Unix (Dilib)
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