High-Dose Chemotherapy and Syngeneic Hemopoietic Stem-Cell Transplantation for Severe, Seronegative Rheumatoid Arthritis
Authors: Geoff McColl, Hitoshi Kohsaka, Jeff Szer, Ian Wicks
Journal: Annals of Internal Medicine (1999)

Brief Communications5 October 1999High-Dose Chemotherapy and Syngeneic Hemopoietic Stem-Cell Transplantation for Severe, Seronegative Rheumatoid ArthritisGeoff McColl, MBBS, FRACP, PhD, Hitoshi Kohsaka, MD, Jeff Szer, MBBS, FRACP, and Ian Wicks, MBBS, FRACP, PhDGeoff McColl, MBBS, FRACP, PhDFrom The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.Search for more papers by this author, Hitoshi Kohsaka, MDFrom The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.Search for more papers by this author, Jeff Szer, MBBS, FRACPFrom The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.Search for more papers by this author, and Ian Wicks, MBBS, FRACP, PhDFrom The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.Search for more papers by this authorAuthor, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-131-7-199910050-00005 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Treatment of severe autoimmune diseases, particularly rheumatoid arthritis, with high-dose chemotherapy and autologous stem-cell transplantation is the subject of considerable debate (1, 2). This discussion has focused on likely outcomes, patient selection, the most appropriate regimen, and whether T-cell depletion of the stem-cell graft might decrease the risk for disease recurrence. We describe a patient with severe, treatment-resistant rheumatoid arthritis who received high-dose cyclophosphamide and antithymocyte globulin. Hemopoietic rescue was achieved with peripheral blood stem cells (PBSCs) from the patient's identical twin brother.Case ReportA 39-year-old man presented with a several-week history of nocturnal fevers, a transient erythematous rash, ...References1. Marmont AM. Immune ablation followed by allogeneic or autologous bone marrow transplantation: a new treatment for severe autoimmune diseases? Stem Cells. 1994;12:125-35. CrossrefMedlineGoogle Scholar2. Wicks I, Cooley H, Szer J. Autologous hemopoietic stem cell transplantation: a possible cure for rheumatoid arthritis? Arthritis Rheum. 1997;40:1005-11. CrossrefMedlineGoogle Scholar3. 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Bone Marrow Transplant. 1997;19:643-5. CrossrefMedlineGoogle Scholar16. Cooley HM, Snowden JA, Grigg AP, Wicks IP. Outcome of rheumatoid arthritis and psoriasis following autologous stem cell transplantation for hematologic malignancy. Arthritis Rheum. 1997;40:1712-5. CrossrefMedlineGoogle Scholar17. Euler HH, Marmont AM, Bacigalupo A, Fastenrath S, Dreger P, Hoffknecht M, et al . Early recurrence or persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation. Blood. 1996;88:3621-5. CrossrefMedlineGoogle Scholar18. Vyse TJ, Todd JA. Genetic analysis of autoimmune disease. Cell. 1996;85:311-8. CrossrefMedlineGoogle Scholar Author, Article, and Disclosure InformationAuthors: Geoff McColl, MBBS, FRACP, PhD; Hitoshi Kohsaka, MD; Jeff Szer, MBBS, FRACP; Ian Wicks, MBBS, FRACP, PhDAffiliations: From The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.Acknowledgment: The authors thank Professor Don Metcalf for critical review of the manuscript.Grant Support: By grants from the National Health and Medical Research Council of Australia and the Reid Charitable Trusts.Corresponding Author: Ian P. Wicks, MBBS, FRACP, PhD, Reid Rheumatology Laboratory, The Walter and Eliza Hall Institute of Medical Research, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, [email protected]acponline.org.Current Author Addresses: Dr. McColl: Centre for Rheumatic Diseases and Rheumatology Unit, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.Dr. Kohsaka: First Department of Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.Associate Professor Szer: Bone Marrow Transplant Service, Department of Clinical Haematology & Medical Oncology, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.Professor Wicks: Reid Rheumatology Laboratory, The Walter and Eliza Hall Institute of Medical Research, Rheumatology Unit and Centre for Rheumatic Diseases, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia. 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