title: Induction of remission of severe and refractory rheumatoid arthritis by allogeneic mixed chimerism.
abstract: This report describes the first allogeneic hematopoietic stem cell transplantation (HSCT) performed for the indication of rheumatoid arthritis (RA). We used nonmyeloablative allogeneic HSCT to treat a 52-year-old woman who had treatment-refractory RA and a poor prognosis (24 swollen and 38 involved joints). She was treated with fludarabine, cyclophosphamide, CAMPATH-1H, and CD34-selected HSCT (8 million CD34+ donor cells/kg); the donor was the patient's HLA-matched, rheumatoid factor-negative sister. One year post-HSCT, the patient has had no infection except dermatomal varicella-zoster virus infection and no acute or chronic graft-versus-host disease (GVHD). Her RA has remained in remission with no immunosuppressive or immunomodulatory medications. The patient is a mixed chimera, with 55% donor T (CD3+) cells and 70% donor myeloid (CD33+) cells. This is the first published report of allogeneic HSCT performed for the indication of RA. Mixed chimerism has resulted in marked amelioration of RA, without GVHD.
authors.affiliation: Division of Immunotherapy, Northwestern University School of Medicine, Chicago, Illinois 60611, USA. rburt@northwestern.edu
authors.forename: Richard K
authors.initials: RK
authors.lastname: Burt
authors.forename: Yu
authors.initials: Y
authors.lastname: Oyama
authors.forename: Larissa
authors.initials: L
authors.lastname: Verda
authors.forename: Kathleen
authors.initials: K
authors.lastname: Quigley
authors.forename: Mary
authors.initials: M
authors.lastname: Brush
authors.forename: Kimberly
authors.initials: K
authors.lastname: Yaung
authors.forename: Laisvyde
authors.initials: L
authors.lastname: Statkute
authors.forename: Ann
authors.initials: A
authors.lastname: Traynor
authors.forename: Walter G
authors.initials: WG
authors.lastname: Barr
mesh_terms: D000074323:Alemtuzumab; D000911:Antibodies, Monoclonal / Q000627:therapeutic use; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm / Q000627:therapeutic use; D015703:Antigens, CD / Q000032:analysis; D015214:Antigens, Differentiation, Myelomonocytic / Q000032:analysis; D018501:Antirheumatic Agents / Q000627:therapeutic use; D001172:Arthritis, Rheumatoid / Q000628:therapy*; D017252:CD3 Complex / Q000032:analysis; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D008875:Middle Aged; D063268:Sialic Acid Binding Ig-like Lectin 3; D018183:Transplantation Chimera; D014740:Vidarabine / Q000031:analogs & derivatives* / Q000627:therapeutic use
chemical_list: D000911:Antibodies, Monoclonal; D061067:Antibodies, Monoclonal, Humanized; D000912:Antibodies, Neoplasm; D015703:Antigens, CD; D015214:Antigens, Differentiation, Myelomonocytic; D018501:Antirheumatic Agents; D017252:CD3 Complex; C571163:CD33 protein, human; D007166:Immunosuppressive Agents; D063268:Sialic Acid Binding Ig-like Lectin 3; D000074323:Alemtuzumab; D003520:Cyclophosphamide; D014740:Vidarabine; C024352:fludarabine