Autologous stem cell transplantation for systemic lupus erythematosus

Some patients with severe systemic lupus erythematosus do not respond to conventional immunosuppression or suffer severe side effects from such treatment. In order to explore the concept of immunoablation followed by haematopoietic stem cell transplantation (HSCT) or 'rescue', an international collaboration has occurred over the past seven years. The European Group for Blood and Marrow Transplantation (EBMT) and The European League Against Rheumatism (EULAR) have analysed their collective phase I and II studies and found a remission rate (based on a reduction of the SLEDAI to < 3) in 66%, one-third of whom later relapsed to some degree. The most often used protocol was cyclophosphamide (CY) and G-CSF for mobilization and CY plus anti thymocyte globulin as conditioning. Procedure related mortality was 12% in this sick group of patients with major organ involvement. The North American, mostly single centre experience showed higher rates of remission and one procedure related death. Some relapse was also observed. Phase II studies designed to assess the role of post-HSCT maintenance therapy are being considered by the EBMT/EULAR group.