STEM-CELL TRANSPLANTATION FOR SEVERE AUTOIMMUNE-DISEASES - NEW PROPOSALS BUT STILL UNANSWERED QUESTIONS

An extensive series of experimental investigations has shown that both inherited and induced autoimmune diseases in laboratory animals may b e transferred and, conversely, cured by stem cell transplantation. In man, the evidence is mainly anecdotal, originating both from the trans mission of autoimmune conditions following allogeneic BMT from carrier donors to non-autoimmune recipients transplant-requiring diseases, an d from the resolution of autoimmune diseases (mainly rheumatoid arthri tis) of the recipients after allogeneic BMT from healthy donors. Will it be possible to cure severe autoimmune diseases with powerfully immu nosuppressive conditioning regimens followed by the administration of hematopoietic stem cells? If the reconstitution of a naive immune syst em is necessary, allogeneic stem cells will be necessary, but the proc edure is still saddled with its attending problems, with TRM in the fo reground. When utilizing autologous stem cells in conjunction with TCD the patients' tolerance will be significantly better, but remissions are to be anticipated rather than cures. However, some special manipul ations may be expected to ameliorate results in those selected autoimm une patients not or badly responding to conventional immunosuppressive therapy, for whom this type of treatment can be offered.