REVIEW - Stem cell transplantation for rheumatic autoimmune diseases

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Arthritis Research & Therapy 2008, 10:217doi:10.1186/ar2486

Review

Published: 10 October 2008

Stem cell transplantation for rheumatic autoimmune diseases

Hügle1 and M van Laar2

1Department of Rheumatology, University of Basel, Felix Platter

Spital, Burgfelderstrasse 101, 4012 Basel, Switzerland

2Musculoskeletal Research Group, Institute of Cellular Medicine, The

Medical School, Framlington Place, Newcastle University, Newcastle

upon Tyne, NE2 4HH, UK

Abstract

Immunoablative therapy and hematopoietic stem cell transplantation

(HSCT) is an intensive treatment modality aimed at 'resetting' the

dysregulated immune system of a patient with immunoablative therapy

and allow outgrowth of a nonautogressive immune system from reinfused

hematopoietic stem cells, either from the patient (autologous HSCT) or

a healthy donor (allogeneic HSCT). HSCT has been shown to induce

profound alterations of the immune system affecting B and T cells,

monocytes, and natural killer and dendritic cells, resulting in

elimination of autoantibody-producing plasma cells and in induction of

regulatory T cells. Most of the available data have been collected

through retrospective cohort analyses of autologous HSCT, case series,

and translational studies in patients with refractory autoimmune

diseases. Long-term and marked improvements of disease activity have

been observed, notably in systemic sclerosis, systemic lupus

erythematosus, and juvenile idiopathic arthritis, and

treatment-related morbidity and mortality have improved due to better

patient selection and modifications of transplant regimens.

Treatment-related mortality has decreased to approximately 7%.

Prospective, randomised, controlled clinical trials are ongoing or

planned in systemic sclerosis, systemic lupus erythematosus, and

several nonrheumatological conditions.

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http://arthritis-research.com/content/10/5/217

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