Prolonged remission of longstanding systemic lupus erythematosus after autologous bone marrow transplant for non-Hodgkin's lymphoma.
We describe a patient with longstanding steroid-dependent systemic lupus erythematosus (SLE) in whom clinical and serological remission was achieved following high-dose therapy and autologous bone marrow rescue for high-grade non-Hodgkin's lymphoma. However, 3 years later, autoimmune disease re-presented in the form of immune thrombocytopenia (ITP), which had not previously been a feature of the SLE, necessitating reintroduction of steroid immunosuppression. Relapse of SLE is most likely, although de novo ITP post-BMT is also a possibility. The case suggests that severe long-standing autoimmune disease may be controlled by high-dose therapy and autologous stem cell reconstitution. However, further studies are required to determine the mechanism of re-emergence of autoimmunity and to evaluate optimal regimens and the potential value of such therapy in severe autoimmune diseases.
Snowden
J A
JA
South Island Bone Marrow Transplant Unit, Christchurch Hospital, New Zealand.
Patton
W N
WN
O'Donnell
J L
JL
Hannah
E E
EE
Hart
D N
DN
D000744:Anemia, Hemolytic, Autoimmune / Q000150:complications / Q000188:drug therapy / Q000276:immunology; D016026:Bone Marrow Transplantation; D005260:Female; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology / Q000628:therapy*; D016393:Lymphoma, B-Cell / Q000150:complications* / Q000628:therapy*; D008875:Middle Aged; D013256:Steroids / Q000627:therapeutic use; D013921:Thrombocytopenia / Q000150:complications / Q000175:diagnosis / Q000276:immunology; D013997:Time Factors; D014182:Transplantation, Autologous
D013256:Steroids