Chemotherapy and Autologous Stem-Cell Transplant Show Long-term Benefit for RA

[Guest guest]

Chemotherapy and Autologous Stem-Cell Transplant Show Long-term Benefit for

RA

Emma Hitt, PhD

Oct. 31, 2002 (New Orleans) ‹ High-dose cyclophosphamide and autologous

stem-cell transplantation appear to improve quality of life and prevent

joint destruction for as long as two years, according to a report presented

here Monday at the American College of Rheumatology (ACR) 66th Annual

Scientific Meeting.

M. van Laar, MD, from Leiden University Medical Center, Netherlands,

and colleagues treated 12 patients with active, progressively erosive

rheumatoid arthritis, who were refractory to conventional treatments.

Patients received high-dose cyclophosphamide followed by autologous

hematopoietic stem-cell transplant. The researchers assessed the patients'

quality of life every three months for two years and X-rayed their hands and

feet at baseline, one, and two years.

According to the researchers, the mean quality of life improved in the first

15 to 18 months, and by 12 months, physical functioning improved (P=.105),

as did role limitations (P=.13), pain (P=.03), vitality (P=.04), and health

(P=.05).

" Social functioning, mental health, and general health perception were less

affected, although these factors did improve, " Dr. van Laar and colleagues

suggest.

Mobility, walking and bending, hand and finger function, arm function, and

ability to perform household tasks also improved. Likewise, progression of

joint damage appeared to slow.

" We are pleased with the apparent efficacy of this treatment and that it

appeared to be maintained for a long period, " Dr. van Laar told Medscape.

Patients most eligible for this type of treatment are those with " a

therapy-refractory disease who are at risk of functional disability and

early mortality, " he said.

E. Yocum, MD, from the University of Arizona in Tucson, who moderated

a session on " difficult " rheumatoid arthritis, said that this procedure is

being performed at a few centers in the United States. But he told Medscape

that " the procedure is falling off in popularity. "

" People are realizing that the benefit sometimes lasts only about 6 months

or so, and there are significant side effects, " he said. " I think it needs

more testing and to be looked at a little more closely. "

According to Dr. Yocum, mostly patients with very severe disease are having

this procedure, but it could be more useful for patients during the early

stages of the disease.

However, he suggested that the therapy might be appropriate for " a small set

of patients with disease that does not respond to these newer therapies, as

well as for patients with lupus or scleroderma. "

ACR 66th Annual Meeting: Abstract 1443. Presented Oct. 28, 2002.

Reviewed by D. Vogin, MD