title: Long-Term Insulin Independence in Type 1 Diabetes Mellitus Using a Simplified Autologous Stem Cell Transplant.
abstract: Efforts to find a cure for type 1 diabetes have focused on the removal of the autoimmune pathophysiologic substrate, with the use of immunosuppressive regimens including autologous hematopoietic stem cell transplantation (AHSCT).
  
  
  
  The main objective of determining long-term insulin independence as well as changes in glycated hemoglobin (HbA1c). Secondary outcomes were procedure morbidity and the need for hospital management.
  
  
  
  We enrolled patients with type 1 diabetes between 2012 and 2014. Median follow-up was 34 months (range, 25-56 mo).
  
  
  
  Ambulatory care.
  
  
  
  We decided to carry out an AHSCT protocol using a less toxic and affordable simplified method based on fludarabine in an outpatient setting.
  
  
  
  Patients were of both sexes, age 8-25 years, with positive levels of anti-GAD antibodies, a C-peptide level >1.0 ng/mL, and <3 months since diagnosis.
  
  
  
  Insulin independence.
  
  
  
  Sixteen patients were included. Overall response was 81% with seven patients achieving insulin independence (44%); six were partial responders (37%) whereas three were nonresponders (19%). The HbA1c level showed a mean decrease of -2.3% at 6 months in the Insulin Independence group. Median age was 12 years old (range, 8-17 years old). A mean of 11.5 × 10(6) CD34+ cells (SD ± 8.2) was obtained. Related mortality at 100 days was 0% as well as during follow-up. Outpatient setting was 100%.
  
  
  
  Simplified AHSCT in an outpatient setting is a feasible, safe and potentially therapeutic intervention for early-onset type 1 diabetes.
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Olga Graciela
authors: OG
authors: Cantú-Rodríguez
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Fernando
authors: F
authors: Lavalle-González
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Miguel Ángel
authors: MÁ
authors: Herrera-Rojas
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: José Carlos
authors: JC
authors: Jaime-Pérez
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: José Ángel
authors: JÁ
authors: Hawing-Zárate
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: César Homero
authors: CH
authors: Gutiérrez-Aguirre
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Consuelo
authors: C
authors: Mancias-Guerra
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Oscar
authors: O
authors: González-Llano
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Alfonso
authors: A
authors: Zapata-Garrido
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: Jesús Zacarias
authors: JZ
authors: Villarreal-Pérez
authors: Hematology Service (O.G.C.-R., M.A.H.-R., J.C.J.-P., J.A.H.-Z., C.H.G.-A., C.M.-G., O.G.-L., D.G.-A.), and Endocrinology Service (F.L.-G., A.Z.-G., J.Z.V.-P.), Hospital Universitario "Dr José Eleuterio González," Universidad Autónoma de Nuevo León, Monterrey, México 64 460.
authors: David
authors: D
authors: Gómez-Almaguer
mesh_terms: D000293:Adolescent; D000328:Adult; D001786:Blood Glucose / Q000378:metabolism*; D002648:Child; D003922:Diabetes Mellitus, Type 1 / Q000378:metabolism / Q000628:therapy*; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use; D014182:Transplantation, Autologous; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D001786:Blood Glucose; D007166:Immunosuppressive Agents