| Intensive immunosuppression and autologous stem cell transplantation for patients with severe rheumatoid arthritis: the Leiden experience. | |
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MedLine Citation:
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PMID: 11642499 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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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 In 5 patients disease modifying antirheumatic drugs were successfully withdrawn after transplantation.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. |
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Authors:
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J M van Laar; R J Verburg; W E Fibbe; F C Breedveld |
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Publication Detail:
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Type: Clinical Trial; Clinical Trial, Phase I; Clinical Trial, Phase II; Journal Article; Multicenter Study; Research Support, Non-U.S. Gov't |
Journal Detail:
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Title: The Journal of rheumatology. Supplement Volume: 64 ISSN: 0380-0903 ISO Abbreviation: J Rheumatol Suppl Publication Date: 2001 Oct |
Date Detail:
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Created Date: 2001-10-19 Completed Date: 2002-03-13 Revised Date: 2006-11-15 |
Medline Journal Info:
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Nlm Unique ID: 7806058 Medline TA: J Rheumatol Suppl Country: Canada |
Other Details:
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Languages: eng Pagination: 25-7 Citation Subset: IM |
Affiliation:
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Department of Rheumatology, Leiden University Medical Center, The Netherlands. j.m.van_laar@lumc.nl |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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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:
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0/Immunosuppressive Agents; 50-18-0/Cyclophosphamide |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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