Autologous stem cell transplantation for refractory juvenile idiopathic arthritis: analysis of clinical effects, mortality, and transplant related morbidity.
OBJECTIVE
To evaluate the safety and efficacy of autologous stem cell transplantation (ASCT) for refractory juvenile idiopathic arthritis (JIA).


METHODS
Retrospective analysis of follow up data on 34 children with JIA who were treated with ASCT in nine different European transplant centres. Rheumatological evaluation employed a modified set of core criteria. Immunological reconstitution and infectious complications were monitored at three month intervals after transplantation.


RESULTS
Clinical follow up ranged from 12 to 60 months. Eighteen of the 34 patients (53%) with a follow up of 12 to 60 months achieved complete drug-free remission. Seven of these patients had previously failed treatment with anti-TNF. Six of the 34 patients (18%) showed a partial response (ranging from 30% to 70% improvement) and seven (21%) were resistant to ASCT. Infectious complications were common. There were three cases of transplant related mortality (9%) and two of disease related mortality (6%).


CONCLUSIONS
ASCT in severely ill patients with JIA induces a drug-free remission of the disease and a profound increase in general wellbeing in a substantial proportion of patients, but the procedure carries a significant mortality risk. The following adjustments are proposed for future protocols: (1) elimination of total body irradiation from the conditioning regimen; (2) prophylactic administration of antiviral drugs and intravenous immunoglobulins until there is a normal CD4+ T cell count.
De Kleer
I M
IM
Paediatric BMT unit, Suite KC 03.063, University Medical Centre Utrecht, PO box 85090, 3508 AB Utrecht, Netherlands.
Brinkman
D M C
DM
Ferster
A
A
Abinun
M
M
Quartier
P
P
Van Der Net
J
J
Ten Cate
R
R
Wedderburn
L R
LR
Horneff
G
G
Oppermann
J
J
Zintl
F
F
Foster
H E
HE
Prieur
A M
AM
Fasth
A
A
Van Rossum
M A J
MA
Kuis
W
W
Wulffraat
N M
NM
D001171:Arthritis, Juvenile / Q000276:immunology / Q000628:therapy*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006085:Graft Survival; D006305:Health Status Indicators; D006801:Humans; D007223:Infant; D008297:Male; D009894:Opportunistic Infections / Q000209:etiology; D018579:Patient Selection; D012189:Retrospective Studies; D012720:Severity of Illness Index; D033581:Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods*; D016019:Survival Analysis; D016176:T-Lymphocyte Subsets / Q000276:immunology; D019172:Transplantation Conditioning / Q000379:methods; D014182:Transplantation, Autologous; D016896:Treatment Outcome