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Non-myeloablative allogeneic stem cell transplant in a patient with refractory systemic lupus erythematosus

Bone Marrow Transplantation volume 37, pages 979–981 (2006)Cite this article

Systemic lupus erythematosus (SLE) is usually treated with immunosuppressives and steroids. Autologous stem cell transplantation (auto-SCT) following immunoablative chemotherapy is a newer therapy for severe SLE.1, 2 Non-myeloablative auto-SCT has been studied in patients with SLE with promising results.2 Studies have reported 5-year disease-free survival of 50 and 55%, respectively.2 The treatment-related mortality ranged from 2 to 13%.2 Myeloablative allogeneic stem cell transplantation (MST) has been studied for SLE patients. However, high treatment-related mortality associated with MST mitigates the potential benefit and thus cannot be a routine choice of treatment for patients with SLE. Non-myeloablative allogeneic stem cell transplantation (NST) has been established as a novel approach for hematological malignancies or non-malignant disorders. We report a patient with refractory SLE who was treated successfully with allogeneic NST.

A 43-year-old Chinese woman was diagnosed with SLE in October 1997. She had positive anti-SSA, anti-ANA and anti-U1RNP. She was treated with prednisone at 10–30 mg/day for 6 years. She had avascular necrosis of the hip joint. She also developed clinical evidence of lupus nephritis in April 2002. At that time, she was treated with a course of high-dose cyclophosphamide at 1 g monthly for 6 months and methotrexate at 10 mg intravenous weekly for 4 weeks. Her symptoms of myalgia and low-grade fever persisted and became debilitating. She became bed-bound. She had an HLA-matched sibling. She consented to receive allo-SCT with non-myeloablative conditioning chemotherapy off clinical trial. Pre-transplantation laboratory data showed hemoglobin (Hb) 94 g/l, white blood cell (WBC) 3.0 × 109/l, platelets 124 × 109/l, anti-SSA+, anti-ANA+, anti-U1RNP+, C3 1.23 g/l, C4 0.1 g/l and ESR 110 mm/h. Her liver and kidney functions were normal.

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Authors and Affiliations

  1. Hematology division, Zhongshan hospital, Xiamen, Fujian Province, P.R. China

    Q Lu, X Niu & Y Guo

  2. Division of Oncology/Hematology, New York Medical College, Valhalla, NY, USA

    L Lu & D Liu

  3. Department of Medicine, Rheumatology Service, Phelps Memorial Hospital Center, Sleepy Hollow, New York, NY, USA

    G R Parino

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  1. Q Lu
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  6. D Liu
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Correspondence to D Liu.

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Lu, Q., Lu, L., Niu, X. et al. Non-myeloablative allogeneic stem cell transplant in a patient with refractory systemic lupus erythematosus. Bone Marrow Transplant 37, 979–981 (2006). https://doi.org/10.1038/sj.bmt.1705359

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