title: High dose chemotherapy and syngeneic stem cell transplantation in a patient with refractory rheumatoid arthritis: poor response associated with persistence of host autoantibodies and synovial abnormalities.
abstract: BACKGROUND
  Immunoablative therapy combined with haematopoietic stem cell transplantation (SCT) is a possible treatment for patients with severe rheumatoid arthritis (RA).
  
  
  METHODS
  A patient with rheumatoid factor positive, progressively erosive RA, refractive to treatment, was treated with high dose cyclophosphamide, followed by reinfusion of an unmanipulated peripheral blood graft derived from her identical twin sister. The clinical response was unsatisfactory, necessitating reinstitution of treatment with disease modifying antirheumatic drugs, which was associated with persistence of host serum autoantibodies and a cellular infiltrate in synovium, notably of plasma cells.
  
  
  CONCLUSIONS
  The effectiveness of syngeneic SCT may be critically dependent on the degree of immunoablation achieved or on the composition of the graft.
authors.affiliation: Department of Rheumatology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands.
authors.forename: M
authors.initials: M
authors.lastname: van Oosterhout
authors.forename: R J
authors.initials: RJ
authors.lastname: Verburg
authors.forename: E W N
authors.initials: EW
authors.lastname: Levarht
authors.forename: J D
authors.initials: JD
authors.lastname: Moolenburgh
authors.forename: R M
authors.initials: RM
authors.lastname: Barge
authors.forename: W E
authors.initials: WE
authors.lastname: Fibbe
authors.forename: J M
authors.initials: JM
authors.lastname: van Laar
mesh_terms: D000328:Adult; D018501:Antirheumatic Agents / Q000627:therapeutic use*; D001172:Arthritis, Rheumatoid / Q000276:immunology / Q000473:pathology / Q000628:therapy*; D001323:Autoantibodies / Q000097:blood*; D003520:Cyclophosphamide / Q000627:therapeutic use; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D013583:Synovial Membrane / Q000473:pathology*; D017211:Treatment Failure
chemical_list: D018501:Antirheumatic Agents; D001323:Autoantibodies; D007166:Immunosuppressive Agents; D003520:Cyclophosphamide