Document Detail


Intensive immunosuppression and autologous stem cell transplantation for patients with severe rheumatoid arthritis: the Leiden experience.
MedLine Citation:
PMID:  11642499     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
Ten patients with active, destructive rheumatoid arthritis refractory to antirheumatic therapy enrolled in a study to evaluate the effects of intensive immunosuppression followed by autologous stem cell transplantation. Intensive immunosuppression was achieved with high dose cyclophosphamide as part of the mobilization (4 g/m2) and conditioning (200 mg/kg) regimen. The autologous stem cell products were enriched for CD34+ cells to minimize the chance of reinfusing autoreactive lymphocytes. Eight patients completed all consecutive treatment steps, one patient withdrew after mobilization because of improvement, one patient was taken off study because of pulmonary embolism. The treatment appeared feasible and safe, and marked sustained clinical improvement was observed in 6 patients, 2 of whom were previously unresponsive to tumor necrosis factor blocking therapy. In 5 patients disease modifying antirheumatic drugs were successfully withdrawn after transplantation. The treatment induced significant lymphopenia, with low levels of naive CD4+ T cells in particular, without clinical sequelae. Titers of rheumatoid factor dropped but did not normalize.
Authors:
J M van Laar; R J Verburg; W E Fibbe; F C Breedveld
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Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase I; Clinical Trial, Phase II; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't    
Journal Detail:
Title:  The Journal of rheumatology. Supplement     Volume:  64     ISSN:  0380-0903     ISO Abbreviation:  J Rheumatol Suppl     Publication Date:  2001 Oct 
Date Detail:
Created Date:  2001-10-19     Completed Date:  2002-03-13     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  7806058     Medline TA:  J Rheumatol Suppl     Country:  Canada    
Other Details:
Languages:  eng     Pagination:  25-7     Citation Subset:  IM    
Affiliation:
Department of Rheumatology, Leiden University Medical Center, The Netherlands. j.m.van_laar@lumc.nl
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MeSH Terms
Descriptor/Qualifier:
Adult
Arthritis, Rheumatoid / immunology,  physiopathology,  therapy*
CD4 Lymphocyte Count
CD4-Positive T-Lymphocytes / immunology
Combined Modality Therapy
Cyclophosphamide / therapeutic use*
Female
Hematopoietic Stem Cell Transplantation*
Humans
Immunocompromised Host
Immunosuppressive Agents / therapeutic use*
Leukapheresis
Male
Middle Aged
Netherlands
Transplantation Conditioning*
Transplantation, Autologous
Treatment Outcome
Chemical
Reg. No./Substance:
0/Immunosuppressive Agents; 50-18-0/Cyclophosphamide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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