[Study of treatment of refractory rheumatoid arthritis with autologous peripheral blood stem cell transplantation].
OBJECTIVE
To explore the efficacy, safety and immune reconstitution of autologous peripheral blood stem cell transplantation (APBSCT) using T cell depleted grafts in the treatment of refractory rheumatoid arthritis (RA).


METHODS
One patient with RA was treated with APBSCT. The method included mobilization with 2 g/m(2) cyclophosphamide (CY) and subcutaneous injection of granulocyte-colony stimulating factor (G-CSF). Immunomagnetic selection of CD34(+) cells from the leukapheresis products was performed to deplete potentially autoreative lymphocytes. The conditioning regimen consisted of intravenous administration of 2 g/m2 CY and 90 mg/kg ATG, with subsequent reinfusion of the graft. G-CSF was used to help hematopoietic and immunologic reconstitution. Phenotype of the peripheral blood lymphocytes was analyzed to observe the immunologic reconstitution after transplantation.


RESULTS
The patient completed the mobilization, conditioning regimen and transplantation successfully. The hematologic recovery was rapid and the patient achieved clinical remission. The erythrocyte sedimentation rate (ESR), C-reactive protein (CRP) decreased to normal level and the rheumatoid factor (RF) turned negative after a follow-up of 12 months. An ongoing course of immunologic reconstitution was observed.


CONCLUSIONS
APBSCT is effective and safey for refractory RA, and can induce improvement of disease activity. The course of immunologic reconstitution after transplantation remains to be observed in long-term followup.
Leng
Xiaomei
X
Department of Rheumatology, Peking Union Medical College Hospital, and Peking Medical College, Chinese Academy of Medical Science Beijing, China.
Zhao
Yan
Y
Zhou
Daobin
D
Li
Taisheng
T
Tang
Fulin
F
Zeng
Xiaofeng
X
Zhang
Fengchun
F
Dong
Yi
Y
Zhao
Yongqiang
Y
Shen
Ti
T
D000328:Adult; D001172:Arthritis, Rheumatoid / Q000097:blood / Q000276:immunology / Q000628:therapy*; D001799:Blood Sedimentation; D002097:C-Reactive Protein / Q000378:metabolism; D015704:CD4 Antigens / Q000032:analysis; D016516:CD4-CD8 Ratio; D016827:CD8 Antigens / Q000032:analysis; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D012074:Remission Induction; D012217:Rheumatoid Factor / Q000097:blood; D014182:Transplantation, Autologous; D016896:Treatment Outcome
D015704:CD4 Antigens; D016827:CD8 Antigens; D002097:C-Reactive Protein; D012217:Rheumatoid Factor