Autologous hematopoietic stem cell transplantation for 3 patients with severe juvenile rheumatoid arthritis.
We performed autologous CD34+ stem cell transplantation in 3 patients with juvenile rheumatoid arthritis (JRA) refractory to conventional treatment. All patients had systemic type JRA. In case 1 (a 3-year-old boy), purified CD34+ cells from bone marrow were transplanted after a preconditioning regimen consisting of cyclophosphamide (200 mg/kg) and antithymocyte globulin (ATG) (40 mg/kg). However, the disease flared soon after transplantation. In case 2 (a 13-year-old girl) and case 3 (a 21-year-old woman), a preconditioning regimen consisting of etoposide (VP16) (2 g/m2), thiotepa (300 mg/m2), and ATG (40 mg/kg) was followed by transplantation of purified CD34+ stem cells harvested from peripheral blood mononuclear cells. The patients in cases 2 and 3 attained complete remission without any medication. Thus for patients with refractory JRA, autologous CD34+ cell transplantation appears to be a safe and feasible choice of treatment in terms of good quality of life. However, a greater number of patients and a longer observation period are needed before definitive conclusions can be drawn.
Kishimoto
Tomoko
T
Department of Pediatrics, Osaka Medical Center and Research Institute for Maternal and Child Health, Izumi City, Osaka, Japan.
Hamazaki
Takashi
T
Yasui
Masahiro
M
Sasabe
Makoto
M
Okamura
Takayuki
T
Sakata
Naoki
N
Inoue
Masami
M
Yagi
Keiko
K
Kawa
Keisei
K
D000293:Adolescent; D000328:Adult; D000894:Anti-Inflammatory Agents, Non-Steroidal / Q000627:therapeutic use; D001171:Arthritis, Juvenile / Q000188:drug therapy / Q000628:therapy*; D001327:Autoimmune Diseases / Q000188:drug therapy / Q000628:therapy*; D002675:Child, Preschool; D003131:Combined Modality Therapy; D036101:Cord Blood Stem Cell Transplantation; D017809:Fatal Outcome; D005260:Female; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008297:Male; D036102:Peripheral Blood Stem Cell Transplantation; D012074:Remission Induction; D019172:Transplantation Conditioning; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous
D000894:Anti-Inflammatory Agents, Non-Steroidal; D007166:Immunosuppressive Agents