PMID- 15119545
OWN - NLM
STAT- MEDLINE
DCOM- 20040722
LR  - 20170214
IS  - 0961-2033 (Print)
IS  - 0961-2033 (Linking)
VI  - 13
IP  - 3
DP  - 2004
TI  - Autologous stem cell transplantation for systemic lupus erythematosus.
PG  - 168-76
AB  - Systemic lupus erythematosus (SLE) is responsive to treatment with 
      immunosuppressives and steroids, but often pursues a relapsing or refractory 
      course resulting in increasing incapacity and reduced survival. Autologous stem 
      cell transplantation (ASCT) following immunoablative chemotherapy is a newer 
      therapy for autoimmune disease of potential use in severe SLE. A retrospective 
      registry survey was carried out by the European Blood and Marrow Transplant and 
      European League Against Rheumatism (EBMT/EULAR) registry. Data was collected from 
      53 patients with SLE treated by ASCT in 23 centres. Disease duration before ASCT 
      was 59 (2-155) months (median, range), 44 (83%) were female, and median age was 
      29 (9-52) years. At the time of ASCT a median of seven American College of 
      Rheumatology (ACR) diagnostic criteria for SLE were present (range 2-10) and 33 
      (62%) had nephritis. Peripheral blood stem cells were mobilized with 
      cyclophosphamide and granulocyte colony stimulating factor in 93% of cases. Ex 
      vivo CD34 stem cell selection was performed in 42% of patients. Conditioning 
      regimens employed cyclophosphamide in 84%, anti-thymocyte globulin in 76% and 
      lymphoid irradiation in 22%. The mean duration of follow-up after ASCT was 26 
      (0-78) months. Remission of disease activity (SLEDAI < 3) was seen in 33/50 (66%; 
      95%CI 52-80) evaluable patients by six months, of which 10/31 (32%; 95%CI 15-50) 
      subsequently relapsed after six (3-40) months. Relapse was associated with 
      negative anti-double stranded DNA (anti-dsDNA) antibodies before ASCT (P = 
      0.007). There were 12 deaths after 1.5 (0-48) months, of which seven (12%; 95%CI 
      3-21) were related to the procedure. Mortality was associated with a longer 
      disease course before ASCT (P = 0.036). In conclusion, this registry study 
      demonstrates the efficacy of ASCT for remission induction of refractory SLE, 
      although mortality appeared high. The safety of this procedure is likely to be 
      improved by patient selection and choice of conditioning regimen. The return of 
      disease activity in one-third of patients might be reduced by long-term 
      immunosuppressive therapy post-ASCT.
FAU - Jayne, David
AU  - Jayne D
AD  - Department of Medicine, Addenbrooke's Hospital, Cambridge, UK. dj106@cam.ac.uk
FAU - Passweg, Jacob
AU  - Passweg J
FAU - Marmont, Alberto
AU  - Marmont A
FAU - Farge, Dominique
AU  - Farge D
FAU - Zhao, Xiaowu
AU  - Zhao X
FAU - Arnold, Renate
AU  - Arnold R
FAU - Hiepe, Falk
AU  - Hiepe F
FAU - Lisukov, Igor
AU  - Lisukov I
FAU - Musso, Maurizio
AU  - Musso M
FAU - Ou-Yang, Jian
AU  - Ou-Yang J
FAU - Marsh, Judith
AU  - Marsh J
FAU - Wulffraat, Nico
AU  - Wulffraat N
FAU - Besalduch, Juan
AU  - Besalduch J
FAU - Bingham, Sarah J
AU  - Bingham SJ
FAU - Emery, Paul
AU  - Emery P
FAU - Brune, Mats
AU  - Brune M
FAU - Fassas, Athanasios
AU  - Fassas A
FAU - Faulkner, Lawrence
AU  - Faulkner L
FAU - Ferster, Alina
AU  - Ferster A
FAU - Fiehn, Christoph
AU  - Fiehn C
FAU - Fouillard, Loic
AU  - Fouillard L
FAU - Geromin, Antonella
AU  - Geromin A
FAU - Greinix, Hildegard
AU  - Greinix H
FAU - Rabusin, Marco
AU  - Rabusin M
FAU - Saccardi, Riccardo
AU  - Saccardi R
FAU - Schneider, Peter
AU  - Schneider P
FAU - Zintl, Felix
AU  - Zintl F
FAU - Gratwohl, Alois
AU  - Gratwohl A
FAU - Tyndall, Alan
AU  - Tyndall A
CN  - European Group for Blood and Marrow Transplantation
CN  - European League Against Rheumatism Registry
LA  - eng
PT  - Comparative Study
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Lupus
JT  - Lupus
JID - 9204265
SB  - IM
MH  - Adolescent
MH  - Adult
MH  - Chi-Square Distribution
MH  - Child
MH  - Cohort Studies
MH  - Europe
MH  - Female
MH  - Humans
MH  - Lupus Erythematosus, Systemic/*diagnosis/mortality/*therapy
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Proportional Hazards Models
MH  - Registries
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Statistics, Nonparametric
MH  - Stem Cell Transplantation/adverse effects/*methods
MH  - Survival Analysis
MH  - Transplantation Conditioning/*methods
MH  - Transplantation, Autologous
MH  - Treatment Outcome
EDAT- 2004/05/04 05:00
MHDA- 2004/07/23 05:00
CRDT- 2004/05/04 05:00
PHST- 2004/05/04 05:00 [pubmed]
PHST- 2004/07/23 05:00 [medline]
PHST- 2004/05/04 05:00 [entrez]
AID - 10.1191/0961203304lu525oa [doi]
PST - ppublish
SO  - Lupus. 2004;13(3):168-76. doi: 10.1191/0961203304lu525oa.