Stem-Cell Transplants: A Cure for Arthritis?

[Guest guest]

Arthritis Foundation

http://www.arthritis.org/resources/news/news_stemupdate.asp

" Stem-Cell Transplants: A Cure for Arthritis? "

Recently, Good Morning America featured a young girl with juvenile

rheumatoid arthritis who had been treated with a stem-cell transplant,

and the same procedure was subject of a study published in the medical

journal The Lancet reporting successful treatment of people with lupus.

Stem-cell transplants have been studied in Europe, Australia and the

United States as a potential treatment for a several forms of arthritis,

including juvenile rheumatoid arthritis, lupus, rheumatoid arthritis and

scleroderma. However, while this therapy appears to be promising, it

isn't for everyone. The Arthritis Foundation wanted to give you an

update on this exciting treatment.

What is a stem-cell transplant?

A stem-cell transplant is a procedure where bone marrow is extracted

from either the person with the disease, or a healthy donor. The

transplants done to date in people with arthritis have only involved

bone marrow cells taken from the person with arthritis - so-called

" autologous " stem-cell transplantation. Most of the bone marrow cells

are removed leaving predominately " stem cells, " or immature bone marrow

cells that have the potential to grow, divide and develop.

Meanwhile, the person undergoing the transplant is put through a

" cleansing system " to eliminate cells in the bone marrow in the body.

This cleansing usually is achieved through high-dose chemotherapy or

radiation treatment that dramatically suppresses the immune system. When

this is done, the purified stem cells from the extraction are injected

back into the body where they, hopefully, will repopulate the marrow

with healthy cells, causing a complete remission.

Can I have this procedure done?

This is a risky procedure and is only performed on people with severe,

life-threatening arthritis who have failed with all other standard

therapy. In several meetings dedicated to stem-cell transplantation in

children with rheumatic diseases, pediatric rheumatologists and bone

marrow specialists from North America and Europe worked to develop

guidelines for deciding who should be considered a candidate for this

treatment, details about the preparation of both the stem cells and the

patients, and information to be gathered before and after the transplant

so as to better understand the impact of the procedure on the person.

Currently stem-cell transplantation is considered an investigational

procedure, and is only preformed in specialized centers participating in

research studies of the procedure.

What are the risks?

A major consequence of stem-cell transplants is suppression of the

immune system, which means the body's defense mechanisms are completely

wiped out. Therefore, the common cold or a normally harmless virus could

lead to a serious, and even life-threatening, infection. To ward against

this, hospitalization is required until all treatment is completed, but

this doesn't insure protection against infection or other complications.

In addition, there is a risk that the transplanted cells will not

repopulate successfully. This could mean that you can be left with no or

a partially effective immune system.

Because of these risks, death occurs in five to 15 percent of all

stem-cell transplants.

How long does it take?

You can expect to spend between several weeks to several months in the

hospital, depending on how your body reacts, complications that may

arise and, most importantly, how quickly the stem cells develop into an

adequate immune system.

Will this cure me?

Calling a successful stem-cell transplant a cure is still under debate.

" I would say that with the information we have at this time, stem-cell

transplantation may have been a cure for some of the patients, " says

Lovell, MD, a pediatric rheumatologist at Children's Hospital

Medical Center in Cincinnati, Ohio. While there is often no evidence of

the primary disease after a transplant, Dr. Lovell feels that the

procedure needs more long-term follow-up before saying that it is

definitely a cure. He points out that some of the successful transplant

recipients have experienced a recurrence of disease, although the

activity was not as severe as it was before.

" This is very high-tech, high-risk medicine, " Dr. Lovell emphasizes. " It

is for people who have no other options. "

I'll tell you where to go!

Mayo Clinic in Rochester

http://www.mayoclinic.org/rochester

s Hopkins Medicine

http://www.hopkinsmedicine.org