title: Current state and future directions of autologous hematopoietic stem cell transplantation in systemic lupus erythematosus.
abstract: Autologous haematopoietic stem cell transplantation (AHSCT) has been proposed as a treatment modality which may arrest the autoimmune disease process and lead to sustained treatment-free remissions. Since the first consensus statement in 1997, approximately 200 autologous bone marrow or haematopoietic stem cell transplantations (HSCTs) have been reported worldwide for systemic lupus erythematosus (SLE). The current state of AHSCT in SLE was reviewed at a recent meeting of the autoimmune working party of the European Group for Blood and Marrow Transplantation. There was general agreement among experts in this field that in patients with severe SLE refractory to conventional immunosuppressive treatments, AHSCT can achieve sustained clinical remissions (ranging from 50% to 70% disease-free survival at 5 years) associated with qualitative immunological changes not seen with other forms of treatment. However, this clinical benefit is associated with an increase in short-term mortality in most studies. Improving patient selection, long-term follow-up of patients after AHSCT, optimisation of induction and maintenance treatment together with detailed analysis of the immune system are identified as key areas for future research. Optimally, AHSCT should be compared with conventional treatment in randomised controlled trials. Development of stronger transplant registries, defining a core set of clinical data and standardising biological sample collections would make future collaborations and comparison of studies more feasible.
authors.affiliation: National Institute of Dental and Craniofacial Research, National Institutes of Health, Bethesda, Maryland 20892, USA. illeig@mail.nih.gov
authors.forename: Gabor G
authors.initials: GG
authors.lastname: Illei
authors.forename: Ricard
authors.initials: R
authors.lastname: Cervera
authors.forename: Richard K
authors.initials: RK
authors.lastname: Burt
authors.forename: Andrea
authors.initials: A
authors.lastname: Doria
authors.forename: Falk
authors.initials: F
authors.lastname: Hiepe
authors.forename: David
authors.initials: D
authors.lastname: Jayne
authors.forename: Steven
authors.initials: S
authors.lastname: Pavletic
authors.forename: Thierry
authors.initials: T
authors.lastname: Martin
authors.forename: Alberto
authors.initials: A
authors.lastname: Marmont
authors.forename: Riccardo
authors.initials: R
authors.lastname: Saccardi
authors.forename: Alexandre E
authors.initials: AE
authors.lastname: Voskuyl
authors.forename: Dominique
authors.initials: D
authors.lastname: Farge
mesh_terms: D035843:Biomedical Research / Q000379:methods; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods* / Q000639:trends; D006801:Humans; D008180:Lupus Erythematosus, Systemic / Q000401:mortality / Q000628:therapy*; D012074:Remission Induction; D016019:Survival Analysis; D016896:Treatment Outcome