REVIEW - Will hematopoietic stem cell transplantation cure human autoimmune diseases?

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J Autoimmun. 2008 May;30(3):145-50.

Will hematopoietic stem cell transplantation cure human autoimmune diseases?

Marmont AM.

II Division of Hematology and Stem Cell Transplantation Center,

Azienda Ospedaliera-Universitaria S. o, Genova, Italy.

Hematopoietic stem cell transplantation is becoming an accepted

therapy for severe autoimmune diseases, and over 1,000 patients have

been transplanted worldwide. Diseases include neurological (multiple

sclerosis, others), rheumatological (systemic sclerosis, systemic

lupus erythematosus, rheumatoid arthritis, vasculitis), haematological

(aplastic anemia, single line immune mediated cytopenias) and others.

The aim of this article is not to review the copious specific

literature, but to analyze whether the up to now existing evidence

satisfies the requirements of cure. Prospective randomized trials have

been launched by the European Group of Blood and Marrow

Transplantation (EBMT). Autologous transplantation, by far the most

widely utilized because of its safety, has been shown to possess a

powerful disease-arresting effect, but whether the attendant immune

reconstitution ( " re-education " ) will finally lead to cure is not

demonstrated. The experience with allogeneic transplantation is too

limited to draw even tentative conclusions. A

Graft-versus-Autoimmunity effect has been ascertained both

experimentally and clinically, but cure of autoimmunity by this

procedure has not been demonstrated. Unexpected relapses in spite of

full donor chimerism have been published. Further experience and

studies are necessary.

PMID: 18222646

http://www.ncbi.nlm.nih.gov/pubmed/18222646

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