First allogeneic hematopoietic stem cell transplantation (HSCT) performed for RA

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Research Article

Induction of remission of severe and refractory rheumatoid

arthritis by allogeneic mixed chimerism

K. Burt *, Yu Oyama, Larissa Verda, Kathleen Quigley,

Brush, Yaung, Laisvyde Statkute, Ann Traynor, Walter G. Barr

Northwestern University School of Medicine, Chicago, Illinois

email: K. Burt (rburt@...)

*Correspondence to K. Burt, Division of Immunotherapy,

Northwestern University Medical Center, 320 East Superior, Room 3-489,

Chicago, IL 60611

Abstract

This report describes the first allogeneic hematopoietic stem cell

transplantation (HSCT) performed for the indication of rheumatoid

arthritis (RA). We used nonmyeloablative allogeneic HSCT to treat a

52-year-old woman who had treatment-refractory RA and a poor prognosis

(24 swollen and 38 involved joints). She was treated with fludarabine,

cyclophosphamide, CAMPATH-1H, and CD34-selected HSCT (8 million CD34+

donor cells/kg); the donor was the patient's HLA-matched, rheumatoid

factor-negative sister. One year post-HSCT, the patient has had no

infection except dermatomal varicella-zoster virus infection and no

acute or chronic graft-versus-host disease (GVHD). Her RA has remained

in remission with no immunosuppressive or immunomodulatory medications.

The patient is a mixed chimera, with 55% donor T (CD3+) cells and 70%

donor myeloid (CD33+) cells. This is the first published report of

allogeneic HSCT performed for the indication of RA. Mixed chimerism has

resulted in marked amelioration of RA, without GVHD.

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Received: 4 November 2003; Accepted: 5 May 2004

http://www3.interscience.wiley.com/cgi-bin/abstract/109581978/ABSTRACT

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