title: Improving safety of autologous haematopoietic stem cell transplantation in patients with Crohn's disease.
abstract: To evaluate the feasibility and toxicity of autologous haematopoietic stem cell transplantation (HSCT) for the treatment of refractory Crohn's disease (CD).
  
  
  
  In this prospective study, patients with refractory CD suffering an aggressive disease course despite medical treatment, impaired quality of life and in whom surgery was not an acceptable option underwent HSCT. Toxicity and complications during the procedure and within the first year following transplantation were evaluated, along with the impact of the introduction of supportive measures on safety outcomes.
  
  
  
  26 patients were enrolled. During mobilisation, 16 patients (62%) presented febrile neutropaenia, including one bacteraemia and two septic shocks. Neutropaenia median time after mobilisation was 5 days. 5 patients withdrew from the study after mobilisation and 21 patients entered the conditioning phase. Haematopoietic recovery median time for neutrophils (>0.5×10(9)/L) was 11 days and for platelets (>20×10(9)/L) 4 days. Twenty patients (95%) suffered febrile neutropaenia and three patients (27%) presented worsening of the perianal CD activity during conditioning. Among non-infectious complications, 6 patients (28.5%) presented antithymocyte globulin reaction, 12 patients (57%) developed mucositis and 2 patients (9.5%) had haemorrhagic complications. Changes in supportive measures over the study, particularly antibiotic prophylaxis regimes during mobilisation and conditioning, markedly diminished the incidence of severe complications. During the first 12-month follow-up, viral infections were the most commonly observed complications, and one patient died due to systemic cytomegalovirus infection.
  
  
  
  Autologous HSCT for patients with refractory CD is feasible, but extraordinary supportive measures need to be implemented. We suggest that this procedure should only be performed in highly experienced centres.
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Aranzazu
authors.initials: A
authors.lastname: Jauregui-Amezaga
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Montserrat
authors.initials: M
authors.lastname: Rovira
authors.affiliation: Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Pedro
authors.initials: P
authors.lastname: Marín
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Azucena
authors.initials: A
authors.lastname: Salas
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Susana
authors.initials: S
authors.lastname: Pinó-Donnay
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Faust
authors.initials: F
authors.lastname: Feu
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: J Ignasi
authors.initials: JI
authors.lastname: Elizalde
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Francesc
authors.initials: F
authors.lastname: Fernández-Avilés
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Martínez
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Gutiérrez
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Laura
authors.initials: L
authors.lastname: Rosiñol
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Enric
authors.initials: E
authors.lastname: Carreras
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Alvaro
authors.initials: A
authors.lastname: Urbano
authors.affiliation: Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Miguel
authors.initials: M
authors.lastname: Lozano
authors.affiliation: Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Joan
authors.initials: J
authors.lastname: Cid
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: María
authors.initials: M
authors.lastname: Suárez-Lledó
authors.affiliation: Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain.
authors.forename: Josep
authors.initials: J
authors.lastname: Mensa
authors.affiliation: Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Rimola
authors.affiliation: Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Sonia
authors.initials: S
authors.lastname: Rodríguez
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Mari Carme
authors.initials: MC
authors.lastname: Masamunt
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Dolors
authors.initials: D
authors.lastname: Comas
authors.affiliation: Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain.
authors.forename: Irene
authors.initials: I
authors.lastname: Ruíz
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Anna
authors.initials: A
authors.lastname: Ramírez-Morros
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Gallego
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Ingrid
authors.initials: I
authors.lastname: Ordás
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Julian
authors.initials: J
authors.lastname: Panés
authors.affiliation: Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain.
authors.forename: Elena
authors.initials: E
authors.lastname: Ricart
mesh_terms: D000293:Adolescent; D000328:Adult; D019072:Antibiotic Prophylaxis / Q000379:methods*; D003424:Crohn Disease / Q000097:blood / Q000175:diagnosis / Q000523:psychology / Q000628:therapy; D005260:Female; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects / Q000379:methods; D006801:Humans; D008297:Male; D008991:Monitoring, Physiologic / Q000379:methods; D062072:Patient Acuity; D010976:Platelet Count / Q000379:methods; D011183:Postoperative Complications / Q000175:diagnosis / Q000517:prevention & control; D011446:Prospective Studies; D011788:Quality of Life; D012074:Remission Induction / Q000379:methods; D012720:Severity of Illness Index; D019172:Transplantation Conditioning / Q000379:methods*; D016896:Treatment Outcome
keywords: BONE MARROW TRANSPLANTATION; CROHN'S DISEASE; IBD CLINICAL; IMMUNOLOGY; INFLAMMATORY BOWEL DISEASE