Autologous Hematopoietic Stem Cell Transplantation for Treatment of Refractory Rheumatoid Arthritis / 대한류마티스학회지

ABSTRACT

OBJECTIVE: To investigate the safety and efficacy of immunoablation and subsequent autologous hematopoietic stem cell transplantation (HSCT)in refractory rheumatoid arthritis (RA). METHODS: Three patients with severe,refractory RA were treated.We mobilized autologous hematopoietic stem cells (HSCs)with cyclophosphamide(Cy)and granulocyte colony-stimulating factor.HSCs were collected and enriched ex vivo using CD34-positive immunoselection.Two different immunoablative conditioning regimens were employed; fludarabine-Cy-anti-thymoayte glonulin (ATG)in patients whose disease activity was transiently ameliorated in response to Cy used in stem cell mobilization,or fludarabine-busulfan-ATG in those who didn't show any response to that. RESULTS: Median time to engraftment with an absolute neutrophil count greater than 500/microliter and nontransfused platelet count greater than 20,000/microliter was 15 days (range 12-16)and 9 days (range 7-13),respectively.Regimen-related toxicity was minimal.Two patients were markedly improved at 2 or 3 months after HSCT,repectively.In another patient,disease activity was transiently subsided,but relapsed at 2 months after HSCT,which led to reinstitution of anti-rheumatic medications.This resulted in subsequent marked improvement of disease activity whereas her disease had been refractory to these medications. CONCLUSIONS: These results underscore the feasibility and potential efficacy of intensive immunosuppression followed by autologous HSCT for treatment of refractory rheumatoid arthritis.The durability of remission remains to be clarified.