The status of stem cell transplantation for rheumatoid arthritis: a rheumatologist's view

Stem cell transplantation (SCT) for rheumatoid arthritis will only be appropriate for a very small proportion of patients--those with aggressive disease who have had inadequate responses to several disease modifying antirheumatic drug regimens, including tumor necrosis factor blockers. The presence of biopsy proven T cell infiltrates in the synovium may be a way to improve appropriate patient selection. While there is general agreement regarding patient selection, the specifics of these criteria are not yet delineated. As for patient selection, the most appropriate SCT regimen has not yet been agreed upon and further pilot studies in this area will be required. In contrast to the above areas in which there is a distinct lack of consensus, outcome measures are better defined in RA and should include remission rate, Disease Activity Scale or American College of Rheumatology 50 (ACR 50) and ACR 70 responses, as well as longterm benefit/risk ratios (or utilities). It would be appropriate to convene a 2-3 day conference in 1-2 years to decide on the above, after more pilot data have been developed.