title: Antiphospholipid syndrome in patients with systemic lupus erythematosus treated by autologous hematopoietic stem cell transplantation.
abstract: Systemic lupus erythematosus (SLE) is the most common disease associated with antiphospholipid syndrome (APS). We, therefore, evaluated 46 patients with refractory SLE treated by autologous hematopoietic stem cell transplantation (HSCT) for a history of APS prior to transplantation. The prevalence of SLE-related APS in our patient population was 61% (28 of 46 patients with refractory SLE). Nineteen of 28 patients with APS had lupus anticoagulant (LA) or high titers of anticardiolipin antibodies (ACLAs), either immunoglobulin (Ig)G or IgM, when evaluated at study entry. Six of 8 evaluable LA+ patients became and remained LA-; 5 of 7 initially ACLA IgG+ patients and 9 of 11 ACLA IgM+ patients demonstrated normalization of ACLA titers when followed after HSCT. Eighteen of 22 patients refractory to chronic anticoagulation discontinued anticoagulation therapy a median of 4 months after transplantation; 78% of them remained free of thrombotic events and in complete SLE remission for up to 78 months (median, 15 months) after HSCT. There was no treatment-related mortality. Autologous HSCT may be performed safely in patients with APS and appears to be effective therapy for eliminating ALPAs and preventing thrombotic complications in patients with SLE.
authors.affiliation: Division of Immunotherapy, Northwestern University Feinberg School of Medicine, Chicago, IL 60611, USA.
authors.forename: Laisvyde
authors.initials: L
authors.lastname: Statkute
authors.forename: Ann
authors.initials: A
authors.lastname: Traynor
authors.forename: Yu
authors.initials: Y
authors.lastname: Oyama
authors.forename: Kim
authors.initials: K
authors.lastname: Yaung
authors.forename: Larissa
authors.initials: L
authors.lastname: Verda
authors.forename: Nela
authors.initials: N
authors.lastname: Krosnjar
authors.forename: Richard K
authors.initials: RK
authors.lastname: Burt
mesh_terms: D000293:Adolescent; D000328:Adult; D016736:Antiphospholipid Syndrome / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000601:surgery*; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects; D006801:Humans; D007075:Immunoglobulin M / Q000276:immunology; D008180:Lupus Erythematosus, Systemic / Q000150:complications* / Q000276:immunology / Q000473:pathology / Q000601:surgery; D008297:Male; D008875:Middle Aged; D013927:Thrombosis / Q000150:complications; D016896:Treatment Outcome
chemical_list: D007075:Immunoglobulin M