Autologous blood stem cell transplantation in refractory systemic lupus erythematosus with severe pulmonary impairment: a case report.
For patients with severe forms of autoimmunity, including systemic lupus erythematosus (SLE), purging autoreactive T cells from the immune repertoire by transplanting autologous hematopoietic stem cells (ASCT) is a therapeutic option. We describe an 18-year-old woman with SLE who had been treated with corticosteroids, azathioprine, cyclophosphamide (CYC), and immunopheresis for 4 years, during which time mechanical ventilation for lupus pneumonitis had been repeatedly required. After the patient was conditioned by administration of CYC and antithymocyte globulin, a total of 8.87 x 10(6) purified CD34+ cells per kg of body weight was infused. Hematopoietic regeneration was observed within 9 days. Twenty-one months after ASCT, the patient continues to be in complete clinical remission, with no signs of SLE-related disease activity and without any immunosuppressive medications. Her pulmonary function has returned to normal. Although a longer followup is required for assessment of the durability of response, the patient's course indicates that ASCT may be a way to reinduce tolerance in patients with SLE.
Brunner
M
M
Internal Medicine I, University of Vienna Medical School, Waehringer Guertel 18-20, A-1090 Vienna, Austria. martin.brunner@univie.ac.at
Greinix
H T
HT
Redlich
K
K
Knöbl
P
P
Smolen
J
J
Leitner
G
G
Derfler
K
K
Graninger
W
W
Kalhs
P
P
Machold
K
K
D000293:Adolescent; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000150:complications / Q000628:therapy*; D011014:Pneumonia / Q000000981:diagnostic imaging / Q000209:etiology / Q000628:therapy*; D012129:Respiratory Function Tests; D014057:Tomography, X-Ray Computed; D014182:Transplantation, Autologous