High-dose immune suppression and autologous hematopoietic stem cell transplantation in refractory Crohn disease.
Two patients with severe Crohn disease, defined by a Crohn Disease Activity Index (CDAI) higher than 250 despite anti-tumor necrosis factor alpha (TNF-alpha), were treated by intense immune suppression and autologous hematopoietic stem cell transplantation (HSCT). Stem cells were mobilized from the peripheral blood using cyclophosphamide (2.0 g/m2) and granulocyte colony-stimulating factor (G-CSF; 5 micro g/kg/d), enriched ex vivo by CD34+ selection, and reinfused after immune conditioning with cyclophosphamide (200 mg/kg) and equine anti-thymocyte globulin (ATG; 90 mg/kg). Patients have remained in remission (CDAI < 100) for 1 year since HSCT. We conclude that further HSCT studies for severe Crohn disease appear warranted.
Burt
Richard K
RK
Division of Immunotherapy, Northwestern University Medical School, Chicago, IL 60611, USA. rburt@nwu.edu
Traynor
Ann
A
Oyama
Yu
Y
Craig
Robert
R
D000293:Adolescent; D000328:Adult; D000890:Anti-Infective Agents / Q000627:therapeutic use; D000961:Antilymphocyte Serum; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D003131:Combined Modality Therapy; D003424:Crohn Disease / Q000188:drug therapy / Q000276:immunology / Q000628:therapy*; D003520:Cyclophosphamide / Q000494:pharmacology; D005260:Female; D016179:Granulocyte Colony-Stimulating Factor / Q000494:pharmacology; D019650:Hematopoietic Stem Cell Mobilization; D006801:Humans; D007108:Immune Tolerance; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000627:therapeutic use*; D017053:Infection Control; D008297:Male; D009503:Neutropenia / Q000209:etiology; D036102:Peripheral Blood Stem Cell Transplantation; D012074:Remission Induction; D016879:Salvage Therapy; D012720:Severity of Illness Index; D013601:T-Lymphocytes; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous / Q000276:immunology
D000890:Anti-Infective Agents; D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D016179:Granulocyte Colony-Stimulating Factor; D003520:Cyclophosphamide