[Autologous hematopoietic stem cell transplantation in systemic lupus erythematosus]

Although the treatment options for systemic lupus erythematosus (SLE) have significantly improved over the past years through the introduction of novel targeted biologic therapies, there are still some patients who suffer from refractory and potentially life-threatening courses of the disease. For these patients autologous hematopoietic stem cell transplantation (ASCT) after immunoablative chemotherapy provides a promising treatment option with curative potential. Based on preclinical models, ASCT was first introduced in 1996 and has since been carried out in approximately 300 patients worldwide. Clinical study results confirmed a disease-free survival in approximately 50 % of patients after 5 years despite termination of immunosuppressive treatment. By careful patient selection and improved anti-infection prophylaxis during stem cell therapy, transplantation-associated mortality could be reduced from an initial 13 % to currently an average of 6 %. Meanwhile, mechanistic studies have provided proof of concept that ASCT not only exerts intensified immunosuppressive effects but is also associated with fundamental qualitative changes of the immune system that may rewire a chronic autoimmune system into a naïve and self-tolerant state: in other words immune reset. Overall, ASCT for SLE is still reserved for patients who do not sufficiently respond to standard therapy. Treatment should be carried out in close cooperation with centers specializing in hematology and only within the framework of clinical studies.