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T-cell depletion improves outcome after autologous stem cell transplant in patients with systemic lupus erythematosus (SLE)

Bone Marrow Transplantation volume 35, pages 205–206 (2005)Cite this article

A Corrigendum to this article was published on 26 January 2005

New treatments must be developed for the 5–10% of systemic lupus erythematosus (SLE) treatment-refractory patients who do not respond to standard immunosuppressive therapies and/or patients with poor prognostic factors in order to improve their current 45% 10-year mortality.1,2,3,4 The goal of hematopoietic stem cell transplant (HSCT) in treatment-refractory SLE is to ablate autoreactive immune cells through high-dose immunosuppressive therapy followed by HSCT. Currently, there are insufficient clinical data to compare unmanipulated vs T-cell-depleted grafts. We describe the outcome of two SLE patients transplanted with autologous stem cells with different degrees of T-cell depletion.

Patient 1 (MM), a 36-year-old Caucasian female, was diagnosed with SLE at 19 years of age. She initially presented with episodes of sterile meningitis that responded to antimalarials and low-dose prednisone. At age 24 she presented with episodes of nephritis, related to class IV membranous nephropathy, which responded to treatment with standard dose cyclophosphamide. At age 31 she had episodes of generalized seizures, lupus-related pancreatitis, bowel vasculitis, cyclophosphamide-refractory renal disease, and pancytopenia. At age 33 she was referred for autologous HSCT. Prior to transplant she had a Systemic Lupus Erythematous Disease Activity Index (SLEDAI) score of 32, elevated serum creatinine, proteinuria, and nondetectable C4 level. She was taking prednisone 30–50 mg and cyclosporine 150 mg daily (Table 1).

Table 1 Identifying and descriptive data for patients undergoing treatment
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Authors and Affiliations

  1. School of Medicine, University of California San Diego, San Diego, CA, USA

    M R Kamrava

  2. Stanford University, Palo Alto, CA, USA

    E M Anderson

  3. Blood and Marrow Transplantation and Rheumatology Division, Departments of Medicine and Pediatrics, School of Medicine, University of California San Diego, San Diego, CA, USA

    K Kalunian, A Abshey, P Holman, B Medina, E D Ball & E Carrier

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  1. M R Kamrava
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  2. E M Anderson
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  3. K Kalunian
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  4. A Abshey
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  8. E Carrier
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Kamrava, M., Anderson, E., Kalunian, K. et al. T-cell depletion improves outcome after autologous stem cell transplant in patients with systemic lupus erythematosus (SLE). Bone Marrow Transplant 35, 205–206 (2005). https://doi.org/10.1038/sj.bmt.1704738

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