Rheumatoid Arthritis

A retrospective analysis of the first 78 registered patients showed significant improvement, with 67% achieving an ACR-50 response at some time after transplant (Snowden et al., 2004). Most of the patients had failed a median of

5 (range 2-9) conventional disease-modifying antirheumatic drugs (DMARDs) before the transplant. Some degree of relapse was seen in 73% of patients after transplant, but was in most cases relatively easy to control with drugs that had proven ineffective before transplant. At 12 months after transplant, more than half of the patients had achieved an ACR-50 or more, and of these, just over 50% had not restarted DMARDs. The median follow-up was 18 (6-40) months, and at this time the majority of patients received a conditioning regimen of Cy 200 mg/m2 alone and received peripherally harvested stem cells after either granulocyte-colony stimulating factor (G-CSF) or Cy/G-CSF (equal numbers) mobilization. Only one TRM was reported, a patient who, 5 months after transplant (Busulphan/Cy), died of sepsis, with a coincidental non-small-cell lung carcinoma being discovered at autopsy. In the opinion of the investigators, this was not considered to be a transplant-induced tumor. A multicenter trial in Australia failed to show any advantage of CD34 selection of the graft after nonmyeloablative conditioning with Cy (Moore et al., 2002).

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