Hematopoietic stem cell transplantation (HSCT): an approach to autoimmunity.
HSCT provides the opportunity to replace a damaged tissue. It is the most important treatment for high risk hematologic malignant and non malignant disorders. An important challenge in the identification of matched donors/patients is the HLA diversity. The Mexican Bone Marrow Registry (DONORMO) has nowadays > 5000 donors. The prevalent alleles are Amerindian, Mediterranean (Semitic and Spanish genes) and African. In theory, it is possible to find 11% of 6/6 A-B-DR low resolution matches for 70% of patients with Mexican ancestry. We contributed with 39 unrelated, cord blood and autologous HSCT for patients with malignant, genetic and autoimmune disorders. Overall disease survival was 50% (2-7 years) depending on the initial diagnosis, conditioning, disease evolution or other factors. Clinical studies using autologous and unrelated HSC are performed on patients with refractory autoimmune diseases producing mixed results: mainly, T1D, RA, MS, SLE. Improvement has been observed in skin damage and quality of life in SLE and systemic sclerosis. Disease stabilization in 2/3 of MS patients. However, in RA and T1D, initial benefits have been followed by eventual relapse. With growing clinical experience and protocol improvement, treatment-related mortality is decreasing. Proof efficacy will be achieved by comparing HSCT with standard therapy in autoimmunity.
Department of Immunology and Immunogenetics, Instituto de Diagnóstico y Referencia Epidemiológicos-InDRE, Secretary of Health (SSA), Mexico City, Mexico.
Carmen
C
Alaez
Mariana
M
Loyola
Andrea
A
Murguía
Hilario
H
Flores
Araceli
A
Rodríguez
Roberto
R
Ovilla
Gregorio
G
Ignacio
Raquel
R
Amador
Victor
V
Salinas
Fernanda
F
Perez
Danaee
D
Rodríguez
Zoila
Z
Morales
Gonzalo
G
Llinguin
Alejandra
A
Vazquez
Analia
A
Altamirano
Clara
C
Gorodezky
D001327:Autoimmune Diseases / Q000628:therapy*; D015551:Autoimmunity; D006680:HLA Antigens / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D014182:Transplantation, Autologous; D014184:Transplantation, Homologous; D016896:Treatment Outcome
D006680:HLA Antigens