Hematopoietic stem cell transplantation for systemic sclerosis with rapid improvement in skin scores: is neoangiogenesis occurring?
Systemic sclerosis (SSc) is presumed to be an immune-mediated vasculopathy of unknown etiology. SSc is unresponsive to most immune-modulating therapies except for intravenous cyclophosphamide, which is reported to demonstrate some benefit. We, therefore, dose-escalated cyclophosphamide to 200 mg/kg and added rabbit ATG 7.5 mg/kg along with infusion of unselected hematopoietic stem cells to minimize the cytopenic interval. Engraftment occurred rapidly (day 8) with minimal unexpected toxicity, no infections, and unexpectedly rapid improvement in the modified Rodnan Skin Score.
Burt
R K
RK
Department of Medicine, Division of Immunotherapy, Northwestern University Medical Center, 320 East Superior, Searle 3-489, Chicago, IL 60611, USA.
Oyama
Yu
Y
Traynor
A
A
Quigley
K
K
Brush
M
M
Rodriguez
J
J
Barr
W G
WG
D000961:Antilymphocyte Serum / Q000008:administration & dosage; D003520:Cyclophosphamide / Q000008:administration & dosage; D006085:Graft Survival; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000008:administration & dosage / Q000633:toxicity; D018919:Neovascularization, Physiologic; D018579:Patient Selection; D012595:Scleroderma, Systemic / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D012867:Skin / Q000473:pathology; D013997:Time Factors; D016896:Treatment Outcome
D000961:Antilymphocyte Serum; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide