1. ¹Northwestern University Feinberg School of Medicine, Divisions of Immunotherapy, Chicago, IL, USA
2. ²University of California San Diego, Division of Rheumatology, San Diego, CA, USA
3. ³University of North Carolina, Division of Rheumatology, Chapel Hill, NC, USA
4. ⁴Vanderbilt University, Division of Rheumatology, Nashville, TN, USA
5. ⁵University of Pittsburgh School of Medicine, Divisions of Hematology Oncology, Pittsburgh, PA, USA
6. ⁶University of Massachusetts, Division of Hematology Oncology, Worchester, MA, USA
7. ⁷University of Berlin, Division of Rheumatology, Charite Hospital, Berlin, Germany
8. ⁸University of Berlin, Division of Bone Marrow Transplantation, Charite Hospital, Berlin, Germany
9. ⁹Hematology/Stem cell Transplantation, Genoa, Italy
10. ¹⁰University of Colorado, Division of Rheumatology, Denver, CO, USA
11. ¹¹University of Pennsylvania, Department of Radiation Oncology, Philadelphia, PA, USA
12. ¹²Sheffield Teaching Hospitals NHS Trust and University of Sheffield, Blood and Marrow Transplant Programme, Sheffield, England

Correspondence: Dr RK Burt, 320 E. Superior St, Searle 3-489, Chicago, IL 60611, USA. E-mail: rburt@northwestern.edu

Received 10 May 2004; Accepted 16 June 2004; Published online 13 September 2004.

Abstract

Hematopoietic stem cell transplantation (HSCT) is becoming an increasingly recognized indication for treatment of autoimmune diseases and severe immune-mediated disorders. However, multicenter registry data have demonstrated higher than anticipated early toxicity, approximately 10% for autoimmune diseases in general, and 20–27% for diffuse systemic sclerosis (scleroderma). If uncorrected, this high treatment-related mortality will hinder development of stem cell therapy for immune-mediated diseases. In order to develop safer regimens, we address some pitfalls and concepts involved in design and selection of conditioning regimens for autoimmune diseases in general, and because it is associated with the highest regimen-related toxicity, scleroderma in specific.