Autologous Stem-Cell Transplantation for Severe Scleroderma
New England Journal of Medicine,Volume 378, Issue 11, Page 1066-1067, March 2018.
PMID: 29654391 [PubMed - as supplied by publisher]
British Journal of Dermatology,Volume 178, Issue 3, Page e239-e239, March 2018.
Systemic sclerosis: Autologous HSCT is efficacious, but can we make it safer?, Published online: 08 March 2018; doi:10.1038/nrrheum.2018.34Autologous haematopoietic stem cell transplantation (HSCT) has proved efficacious in treating patients with systemic sclerosis, but different regimens have different associated toxicities and different effects on lung function. Through comparison of different clinical trials, we can learn how to improve the safety of HSCT.
Myeloablative autologous hematopoietic stem cell transplantation resulted in significantly better long-term clinical outcomes —although greater toxicity–in patients with scleroderma than did cyclophosphamide, found atrial published in theNew England Journal of Medicine.
CONCLUSIONS: Reactivity towards topo-I-epitopes is heterogeneous in SSc, but peptide 39 (aa647-671) may be another immunodominant epitope besides the published epitope aa489-573. Antibody reactivity to this peptide 39 was higher in group 2- than in group 1-patients. Peptide recognition pattern did not change after aSCT. PMID: 29465357 [PubMed - as supplied by publisher]
In this study, 36 people with severe scleroderma received stem-cell transplantation and were compared with 39 otherwise similar people who received a year of standard immune-suppressing medication. After 4.5 years, those assigned to receive stem-cell transplantation had improved overall survival compared with standard treatment (79% vs. 50%) less need for immune-suppressing medication (9% vs. 44%) fewer deaths related to worsening scleroderma (11% vs. 28%) more deaths related to treatment — (3% vs. 0%). These findings suggest that stem-cell transplantation may be much better than standard treatment for people with ...
• A meta-analysis comparing autologous HSCT to immunosuppression in system sclerosis• Transplantation is associated with a reduction in overall mortality• Transplantation is associated with an improvement in skin thickness, lung function, and quality of life• Autologous SCT is a Disease-Modi fying Anti-Rheumatic Treatment for systemic sclerosis
International Journal of Rheumatic Diseases, EarlyView.
Conclusions Changes in CT-textural features after SCT are associated with visual CT evaluation of SSc-related lung abnormalities, but complementary provide information about therapy-induced, structural pulmonary changes.
British Journal of Dermatology, EarlyView.