The role of autologous haemopoietic stem cell transplantation in the treatment of autoimmune disorders

Abstract Autologous stem cell transplantation (HSCT) has been used for over thirty years for malignant haematological diseases such as myeloma and lymphoma with considerable success. More recently this procedure has been adopted as a form of high dose immunosuppression in selected patients with auto‐immune diseases that are resistant to conventional therapies. Animal models have previously outlined the rationale and validity of HSCT in patients with these non‐malignant, but in many cases, life threatening conditions. Recent data has demonstrated that deletion of putative auto‐reactive immune clones with reconstitution of a thymic driven, tolerant immune system occurs in HSCT for auto‐immune patients. Two randomised control trials have confirmed that HSCT is superior to monthly cyclophosphamide in Systemic Sclerosis with a highly significant disease free and overall benefit demonstrated in the ASTIS trial. Over 2000 patients worldwide with auto‐immune conditions have been treated with HSCT – the commonest indications being Multiple Sclerosis and Systemic Sclerosis. Encouraging relapse free survival of 70‐80% at 4 years, in heavily pre‐treated MS patients, has been demonstrated in Phase II trials. A phase III trial in MS patients who have failed interferon is currently accruing patients. Future challenges include improvements in safety of HSCT, particularly in cardiac assessment of Systemic Sclerosis patients, cost‐benefit analyses of HSCT compared to standard...
Source: Internal Medicine Journal - Category: Internal Medicine Authors: Tags: Review Source Type: research