IMMUNE ABLATION WITH STEM-CELL RESCUE - A POSSIBLE CURE FOR SYSTEMIC LUPUS-ERYTHEMATOSUS

The impressive prolongation of survival has been the most important pr ogress made in clinical systemic lupus erythematosus (SLE). Quality of life has also greatly improved, including pregnancy. However, persist ing disease and therapy-related morbidity outcomes justify new approac hes, different from the usual long-term palliative immunosuppression. Haematopoietic stem cells (HSCs) from healthy histocompatible mice are capable of curing murine SLE after eradication of the original HSCs w ith total body irradiation. Syngeneic and even autologous HSCs are als o capable of curing induced experimental autoimmune diseases such as a djuvant arthritis and experimental allergic encephalomyelitis. In man allogeneic bone-marrow transplantation (BMT) is becoming progressively safer, but cannot yet be offered to SLE patients. However, syngeneic transplants from twins non-concordant for the disease would be justifi ed. Conditioning with high-dose cyclophosphamide followed by autologou s HSC rescue, from the marrow and/or from the peripheral blood, may al ready be regarded as a powerful immunosuppressive procedure for select ed cases of SLE and other severe autoimmune diseases. Autologous trans plant procedures are not saddled with the immunologic problems of allo -BMT. Although eradication of SLE may not be achieved by auto-BMT, min imal residual immunologic disease can be suppressed or controlled, and long-term self-maintained remissions may be expected.