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Year : 2008  |  Volume : 3  |  Issue : 3  |  Page : 101-109

Haematopoietic stem cell transplantation in autoimmune diseases


Department of Haematology & Bone Marrow Transplantation, Army Hospital (R&R), Delhi, India

Correspondence Address:
Velu Nair
Department of Haematology & Bone Marrow Transplantation, Army Hospital (R&R), Delhi
India
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Source of Support: None, Conflict of Interest: None


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Haematopoietic stem cell transplantation (HSCT) comprises the elimination of nonfunctioning, dysfunctional or malignant cells using high-dose chemotherapy with or without radiation therapy. This is followed by stem cell rescue sourced from bone marrow or peripheral blood. In autoimmune disease (AID) the main target is to achieve lym- phoablation. The newly generated lymphoid cells will have a new immunological repertoire which hopefully is not auto-reactive. HSCT aims to 'reset' the dysregulated immune system of AID patients. Most clinical studies reported for HSCT in AID have involved autologous HSCT and have been carried out in patients who have failed to respond to conventional therapies. Many of these patients had advanced active disease, often with organ dysfunction which explains the wide range of transplant-related mortality (TRM) from 1 to 12%. Conditions in which autologous HSCT has been performed with variable degree of success include systemic sclerosis, SLE, RA, JIA, multiple sclerosis and a number of other disorders. Because transplant physicians do not have expertise in AIDs it is vital to actively engage clinical immunologists and rheumatologists in protocol conception for conditioning and post-transplant main- tenance therapy. National and international co-ordination would be helpful in developing guidelines regarding patient selection and defining clinical and scientific endpoints. Hence, all treating teams should comprise of both disease and transplant experts working towards a common goal of achieving maximal benefit with minimal TRM using HSCT in the treatment of AID.


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