T-cell depletion improves outcome after autologous stem cell transplant in patients with systemic lupus erythematosus (SLE)
Kamrava MR, Anderson EM, Kalunian K, Bashey A, Holman P, Medina B, Ball ED, Carrier E. Bone Marrow Transplant. 2005 Jan;35(2):205-6. No abstract available. Erratum in: Bone Marrow Transplant. 2005 Feb;35(3):321.
New treatments must be developed for the 5–10% of systemic lupus erythematosus (SLE) treatment-refractory patients who do not respond to standard immunosuppressive therapies and/or patients with poor prognostic factors in order to improve their current 45% 10-year mortality.1,2,3,4 The goal of hematopoietic stem cell transplant (HSCT) in treatment-refractory SLE is to ablate autoreactive immune cells through high-dose immunosuppressive therapy followed by HSCT. Currently, there are insufficient clinical data to compare unmanipulated vs T-cell-depleted grafts. We describe the outcome of two SLE patients transplanted with autologous stem cells with different degrees of T-cell depletion.
Patient 1 (MM), a 36-year-old Caucasian female, was diagnosed with SLE at 19 years of age.
She initially presented with episodes of sterile meningitis that responded to antimalarials and low-dose prednisone. At age 24 she presented with episodes of nephritis, related to class IV membranous nephropathy, which responded to treatment with standard dose cyclophosphamide. At age 31 she had episodes of generalized seizures, lupus-related pancreatitis, bowel vasculitis, cyclophosphamide-refractory renal disease, and pancytopenia. At age 33 she was referred for autologous HSCT.