Immunoablative Therapy with Bone Marrow or Peripheral Stem Cell Transplantation for Rheumatoid Arthritis and Juvenile Idiopathic Arthritis
January 30, 2009 | Evidence Reports
Immunoablative therapy involves the administration of high-dose chemotherapy (HDC), and sometimes total-body irradiation (TBI), to destroy abnormal immune system cells that are responsible for the disease followed by recon-stitution of the immune system with healthy stem cells harvested from the patient's own (autologous) or a donor's (allogeneic) bone marrow or peripheral stem cells. The patient then receives stem cell transplant (SCT), i.e., reinfusion of stem cells. Interest in immunoablative therapy for rheumatoid arthritis (RA) and juvenile idiopathic arthritis (JIA) arose from observations that cases of pre-existing autoimmune disease coincidental with malignancies have sometimes gone into prolonged remission when the malignancy was treated with immunoablation followed by stem cell transplantation. This therapy has typically been given as a last resort to patients whose disease has not responded to other available treatments, such as disease-modifying drugs.
HDC, TBI, and stem-cell transplantation are inpatient procedures.
The American Society for Blood and Marrow Transplantation (ASBMT) recommends that patients selected to receive SCT for any autoimmune disease, including RA and JIA, have a high risk of mortality or severe disability that is unlikely to be cured by standard therapies. The authors of two retrospective database studies on SCT noted that patients with either of these diseases currently would not be considered for SCT unless they had received unsuccessful treatment with anti-tumor necrosis factors (anti-TNFs). The authors of one database study also suggested that TBI...