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Autologous hematopoietic stem cell transplantation for refractory antiphospholipid syndrome causing myocardial necrosis

Bone Marrow Transplantation volume 33, pages 863–866 (2004)Cite this article

Summary:

Autologous hematopoietic stem cell transplantation (HSCT) is currently being evaluated as a treatment for autoimmune diseases, including systemic lupus erythematosus (SLE), that are associated with a very severe prognosis. We describe a 27-year-old woman with SLE with a 10-year history of refractory antiphospholipid syndrome (APS). She developed progressive myocardial necrosis despite treatment with corticosteroids, cyclophosphamide (CYC), cyclosporine, and immunopheresis. After conditioning with CYC, fludarabine, and antithymocyte globulin, autologous HSCT using CD34+ selection was performed. After transplantation, the clinical symptoms caused by APS remitted, and the serum anticardiolipin antibody level decreased. Remission has persisted for 21 months after transplantation. Although a longer follow-up is required for the assessment of efficacy, autologous HSCT may cure patients with refractory APS.

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References

  1. Harris EN . Antiphospholipid antibodies. Br J Haematol 1990; 74: 1–9.

    Article  CAS  Google Scholar 

  2. Derksen RHWM, Hasselaar P, Blokzijl L, DE Groot PG . Lack of efficacy of plasma-exchange in removing antiphospholipid antibodies. Lancet 1987; 25: 222.

    Article  Google Scholar 

  3. Neuwelt CM, Daikh DI, Linfoot JA et al. Catastrophic antiphospholipid syndrome. Response to repeated plasmapheresis over three years. Arthritis Rheum 1997; 40: 1534–1539.

    Article  CAS  Google Scholar 

  4. Traynor AE, Schroeder J, Rosa RM et al. Treatment of severe systemic lupus erythematosus with high-dose chemotherapy and hematopoietic stem-cell transplantation: a phase I study. Lancet 2000; 356: 701–707.

    Article  CAS  Google Scholar 

  5. Burt RK, Traynor AE, Pope R et al. Treatment of autoimmune disease by intense immunosuppressive conditioning and autologous hematopoietic stem cell transplantation. Blood 1998; 92: 3505–3514.

    CAS  Google Scholar 

  6. Brunner M, Greinix HT, Redlich K et al. Autologous blood stem cell transplantation in refractory systemic lupus erythematosis with severe pulmonary impairment: a case report. Arthritis Rheum 2002; 46: 1580–1584.

    Article  CAS  Google Scholar 

  7. Brown JH, Doherty CC, Allan DC, Morton P . Fatal cardiac failure due to myocardial microthrombi in systemic lupus erythematosus. Br Med J 1988; 296: 1505.

    Article  CAS  Google Scholar 

  8. Griffith GC, Vural IL . Acute and subacute disseminated lupus erythematosus: a correlation of clinical and postmortem findings in eighteen cases. Circulation 1951; 3: 492–500.

    Article  CAS  Google Scholar 

  9. Euler HH, Marmont AM, Bacigalupo A et al. Early recurrence or persistence of autoimmune diseases after unmanipulated autologous stem cell transplantation. Blood 1996; 88: 3621–3625.

    CAS  Google Scholar 

  10. Tyndall A, Gratwohl A . Blood and marrow stem cell transplants in autoimmune disease: a consensus report written on behalf of the European League against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT). Bone Marrow Transplant 1997; 19: 643–645.

    Article  CAS  Google Scholar 

  11. van Bekkum DW . Stem cell transplantation in experimental models of autoimmune disease. J Clin Immunol 2000; 20: 10–16.

    Article  CAS  Google Scholar 

  12. Mukai M, Bohgaki T, Kondo M et al. Changes in the T-helper cell 1/T-helper cell 2 balance of peripheral T-helper cells after autologous peripheral blood stem cell transplantation for non-Hodgkin's lymphoma. Ann Hematol 2001; 80: 715–721.

    Article  CAS  Google Scholar 

  13. Openshaw H, Nash RA, McSweeney PA . High dose immunosuppression and hematopoietic stem cell transplantation in autoimmune disease: clinical review. Biol Blood Marrow Transplant 2002; 8: 233–248.

    Article  CAS  Google Scholar 

  14. Burt RK, Marmont A, Schroeder J et al. Intense immune suppression for systemic lupus – the role of hematopoietic stem cells. J Clin Immunol 2000; 20: 31–37.

    Article  CAS  Google Scholar 

  15. Adachi Y, Inaba M, Amoh Y et al. Effect of bone marrow transplantation on antiphospholipid antibody syndrome in murine lupus mice. Immunobiology 1995; 192: 218–230.

    Article  CAS  Google Scholar 

  16. Olalla JI, Ortin M, Hermida G et al. Disappearance of lupus anticoagulant after allogeneic bone marrow transplantation. Bone Marrow Transplant 1999; 23: 83–85.

    Article  CAS  Google Scholar 

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Acknowledgements

We acknowledge Dr S Nishiyama for providing the clinical data and the nursing staff of Hyogo College of Medicine for their assistance in autologous HSCT.

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Authors and Affiliations

  1. Division of Rheumatology and Clinical Immunology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    N Hashimoto, T Iwasaki, M Sekiguchi & H Sano

  2. Division of Hematology and Oncology, Department of Internal Medicine, Hyogo College of Medicine, Nishinomiya, Hyogo, Japan

    H Takatsuka & T Okamoto

  3. Hashimoto Clinic for Rheumatic Diseases, Chuo-ku, Osaka, Japan

    T Hashimoto

Authors
  1. N Hashimoto
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  2. T Iwasaki
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  5. T Okamoto
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  6. T Hashimoto
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  7. H Sano
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Correspondence to T Iwasaki.

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Hashimoto, N., Iwasaki, T., Sekiguchi, M. et al. Autologous hematopoietic stem cell transplantation for refractory antiphospholipid syndrome causing myocardial necrosis. Bone Marrow Transplant 33, 863–866 (2004). https://doi.org/10.1038/sj.bmt.1704432

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  • DOI: https://doi.org/10.1038/sj.bmt.1704432

Keywords

  • antiphospholipid syndrome
  • hematopoietic stem cell transplantation
  • myocardial necrosis
  • systemic lupus erythematosus

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