Open AccessHigh‐dose chemotherapy and autologous hematopoietic stem cell transplantation in patients with rheumatoid arthritis: Results of an open study to assess feasibility, safety, and efficacy
Author(s) -
Verburg Robert J.,
Kruize Aike A.,
van den Hoogen Frank H. J.,
Fibbe Willem E.,
Petersen Eefke J.,
Preijers Frank,
Sont Jacob K.,
Barge Renée M. Y.,
Bijlsma Johannes W. J.,
van de Putte Leo B.,
Breedveld Ferdinand C.,
van Laar Jacob M.
Publication year - 2001
Publication title -
arthritis & rheumatism
Language(s) - English
Resource type - Journals
eISSN - 1529-0131
pISSN - 0004-3591
DOI - 10.1002/1529-0131(200104)44:4<754::aid-anr131>3.0.co;2-n
Subject(s) - medicine , leukapheresis , filgrastim , surgery , rheumatoid arthritis , transplantation , hematopoietic stem cell transplantation , chemotherapy , cyclophosphamide , autologous stem cell transplantation , adverse effect , granulocyte colony stimulating factor , stem cell , cd34 , genetics , biology
Objective To assess the feasibility, safety, and efficacy of high‐dose chemotherapy and autologous hematopoietic stem cell transplantation (HSCT) in patients with severe, refractory rheumatoid arthritis (RA). Methods Fourteen patients (3 male, 11 female, mean age 43 years, mean disease duration 10 years) with active, destructive, refractory RA entered the study. Autologous hematopoietic stem cells were collected by leukapheresis after mobilization with a single infusion of cyclophosphamide (CYC; 4 gm/m 2 ) and subcutaneous injections of filgrastim (granulocyte colony‐stimulating factor). Immunomagnetic selection of CD34+ cells from the leukapheresis products was performed to deplete potentially autoreactive lymphocytes. The conditioning regimen consisted of intravenous administration of high doses of CYC (cumulative dose 200 mg/kg), with subsequent reinfusion of the graft. Patients were monitored for disease activity, disability, adverse effects, and hematopoietic and immunologic reconstitution. Results All 14 patients completed the mobilization and leukapheresis procedures successfully, and 12 proceeded to receive conditioning and transplantation. Engraftment occurred in all of these patients, with rapid hematologic recovery. No major unexpected toxicity was observed. Marked improvement of disease activity was recorded in 8 of 12 patients at >50% of the visits, with a followup ranging from 7 months to 21 months. The clinical responders included 2 patients who had previously failed treatment with tumor necrosis factor (TNF) blocking agents. Conclusion High‐dose chemotherapy followed by autologous HSCT is feasible and safe, and can result in long‐term improvement of disease activity in patients whose condition previously did not respond to conventional antirheumatic drugs or TNF blocking agents. The persistence of active disease in some patients may reflect the heterogeneity of the underlying disease process.