Fw: Chemo without stem cell transplant treats lupus

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Sent: Friday, January 10, 2003 7:00 PM

Subject: Chemo without stem cell transplant treats lupus

Chemo without stem cell transplant treats lupus

NEW YORK - Some patients with lupus are turning to high doses of chemotherapy to knock out their errant cells, and a small study suggests that this technique need not be accompanied by an extraction and re-infusion of the patient's own immune cells.Lupus is a type of autoimmune disease, in which the immune system attacks the body's own tissues. Patients with the condition typically take drugs to suppress the immune system.Recently, researchers have shown that people with lupus can benefit from a high dose of the chemotherapy drug cyclophosphamide. However, the dose is strong enough to wipe out the bone marrow, which patients need to fight off life-threatening infections. To protect patients, doctors often extract a portion of a patient's bone marrow, or some of his stem cells--which can give rise to various specialized types of cells--before giving him chemotherapy. After treatment, doctors re-infuse the patient with the extracted cells, allowing them to repopulate the body. That may not be the best way to proceed, argue study author Dr. Petri and colleagues at s Hopkins University in Baltimore, land. Giving a patient back his own cells may inadvertently return diseased cells to his body, allowing lupus to recur, they note. And certain stem cells will survive the effects of high-dose cyclophosphamide anyhow, they add, and will automatically repopulate the bone marrow after treatment. "Stem cells, the bone marrow cells that give rise to all immune cells, are resistant to high-dose cyclophosphamide," study co-author Dr. Brodsky said in a statement. "The malfunctioning immune cells are destroyed by the cyclophosphamide, while the stem cells withstand the therapy and continue to rebuild a new, hopefully disease-free immune system," he added. In the current study, 14 patients received a high dose of cyclophosphamide with no stem cell transplant. Five achieved a complete response, meaning they showed no signs of the disease and were able to reduce the dose of the drugs they took to treat their lupus. These improvements continued through the last follow-up, which occurred more than 3 years after treatment in some cases. Another six patients partially improved after the treatment, two others did not respond and one initially improved, then relapsed. All of the patients included in the study had failed to respond to other treatments for their condition. The researchers report their findings in the recent issue of the journal Arthritis & Rheumatism.In people with lupus, or systemic lupus erythematosus (SLE) as it is officially known, the immune system loses the ability to differentiate between its own cells and outside invaders, so it attacks healthy cells including tissue in the joints, kidneys, lungs and other organs. There is no cure. About one out of every 2,000 people in the West has lupus, which mainly strikes women.The standard treatment for patients with moderate or severe forms of lupus involves a monthly dose of cyclophosphamide. Unfortunately, that treatment can have a number of side effects, Petri and her colleagues note, such as infections and ovarian failure. In the current study, however, none of the patients experienced premature ovarian failure. Side effects of the current treatment included hair loss, nausea and low blood cell counts. These findings are preliminary, Petri and her team note, and further studies are needed. SOURCE: Arthritis & Rheumatism 2003;48.gigi* http://www.reutershealth.com/archive/2003/01/10/eline/links/20030110elin004.html