Intense immunosuppression followed by purified blood CD34+ cell autografting in a patient with refractory juvenile rheumatoid arthritis.
A 15-year-old boy with refractory juvenile rheumatoid arthritis (JRA) underwent intense immunosuppressive therapy followed by purified blood CD34+ cell autografting. He had been taking prednisolone (PDN) daily or every other day combined with methotrexate once a week to control the disease for 7 years. He suffered from psychological complications and a very short stature due to the adverse effects of these drugs. CD34+ cells were purified in bulk from G-CSF-mobilized PBSC using an Isolex 300. After the administration of cyclophosphamide (200 mg/kg) and anti-lymphocyte globulin (45 mg/kg), 3.6 x 10(6)/kg purified CD34+ cells were infused. His post-transplant course was uneventful except for herpes-zoster infection. He is now more than 1 year post transplant and has not taken any immunosuppressive medication. His rate of growth has increased (>10 cm/year) due to the effects of the cessation of PDN and the administration of recombinant human growth hormone (rGH), in contrast to the gain of 2 cm in the preceding 3 years with rGH treatment. Although the durability of this remission is unknown, intense immunosuppressive therapy followed by purified blood CD34+ cell autografting might be acceptable for adolescent patients with refractory JRA to achieve a drug-free period for physical and psychological maturation.
Nakagawa
R
R
Department of Pediatrics, University of Tokushima School of Medicine, Japan.
Kawano
Y
Y
Yoshimura
E
E
Suzuya
H
H
Watanabe
T
T
Kanamaru
S
S
Onishi
T
T
Nakayama
H
H
Nakagawa
R
R
Matsuoka
S
S
Yamashita
K
K
Kuroda
Y
Y
D000293:Adolescent; D018952:Antigens, CD34; D000961:Antilymphocyte Serum / Q000008:administration & dosage; D001171:Arthritis, Juvenile / Q000276:immunology* / Q000628:therapy*; D001835:Body Weight; D002469:Cell Separation / Q000379:methods; D003520:Cyclophosphamide / Q000008:administration & dosage; D018572:Disease-Free Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006412:Hematopoietic Stem Cells / Q000166:cytology / Q000276:immunology; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D008297:Male; D011788:Quality of Life; D014182:Transplantation, Autologous / Q000379:methods
D018952:Antigens, CD34; D000961:Antilymphocyte Serum; D003520:Cyclophosphamide