COURSE OF CROHNS-DISEASE AFTER ALLOGENEIC MARROW TRANSPLANTATION

Background & Aims: Remission of several autoimmune diseases has been d escribed after allogeneic marrow transplantation. The aim of this stud y was to determine if the natural history of Crohn's disease was alter ed by hematopoietic cell transplants from healthy allogeneic donors. M ethods: Between 1982 and 1992, 6 patients with Crohn's disease and leu kemia underwent allogeneic marrow transplantation and were followed up clinically. Results: Five patients had active Crohn's disease before transplantation, and 3 had clinical evidence of sclerosing cholangitis . Four marrow donors were HLA-identical siblings, 1 related donor was mismatched at the DR locus, and 1 unrelated donor was HLA-matched. One patient died of septicemia 97 days after transplantation; 5 patients were observed for 4.5, 5.8, 8.4, 9.9, and 15.3 years after transplanta tion. Four of 5 patients evaluated had no signs or symptoms of Crohn's disease after transplantation. One patient with mixed donor-host hema topoietic chimerism had a relapse of Crohn's disease 1.5 years after t ransplantation. Conclusions: Four of 5 patients followed up for 4.5 to 15.3 years after allogeneic hematopoietic cell transplantation remain ed free of Crohn's disease. These observations suggest that host immun e dysregulation plays a role in the perpetuation of Crohn's disease th at can be corrected by allogeneic hematopoietic cell transplantation.