Current perspectives of autologous stem cell transplantation for severe juvenile idiopathic arthritis

Autor:	NM Wulffraat, D. M. C. Brinkman, E. M. van Rooijen, R. Tewarie, Berent J. Prakken, Wietse Kuis
Rok vydání:	2008
Předmět:	Drug medicine.medical_specialty Transplantation Conditioning Adolescent Cyclophosphamide media_common.quotation_subject Immunology Arthritis Cohort Studies Autologous stem-cell transplantation Internal medicine Humans Immunology and Allergy Medicine Child Interleukin 6 media_common biology business.industry Remission Induction Interleukin Total body irradiation medicine.disease Arthritis Juvenile Cohort biology.protein business Immunosuppressive Agents Stem Cell Transplantation medicine.drug
Zdroj:	Autoimmunity. 41:632-638
ISSN:	1607-842X 0891-6934
DOI:	10.1080/08916930802200224
Popis:	The majority of children with Juvenile Idiopathic Arthritis can nowadays be treated adequately. However despite the use of combinations of antirheumatic drugs, corticosteroids and the newer so called biologicals (blocking the TNF, Interleukin 1 or Interleukin 6 pathways) a proportion of children with arthritis remain resistant also to these therapies and suffer from a very severe, debilitating and potentially fatal disease. For such children autologous stem cell transplantation (ASCT) is successfully performed since 1997. Here we describe the long term outcome of the initial cohort of children with resistant Juvenile Idiopathic arthritis, treated with ASCT. The initial cohort of children was treated with a conditioning regimen containing Cyclophosphamide, anti thymocyte globulins and low dose Total Body irradiation. Overall favourable responses were seen, with a drug free remission rate of 50-55 %. In the more recent years late relapses were noted with lower percentages for drug free long term outcome. Special emphasis is given on 2 cases showing very late relapses, occurring after 7 and 9 years. The observed relapses are often less severe compared to the situation before SCT and can be treated successfully with conventional drugs in the majority of cases. More recently, ASCT was performed in 4 JIA children with a fludarabin containing regimen in stead of low dose TBI. With a 4 to 5 year follow up, these 4 patients are all in drug free full remission. Allogeneic transplant with an HLA matched family donor was reported in 2 JIA cases. Follow up of 1 and 3 year is sofar show clinical disease remission and tapering of medition. In conclusion, given the favourable long term outcome, SCT remains a valuable treatment option for children with drug resistant JIA.
Databáze:	OpenAIRE
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