AUTOLOGOUS STEM-CELL TRANSPLANTATION FOR AUTOIMMUNE-DISEASES - ISSUESIN PROTOCOL DEVELOPMENT

For patients with autoimmune disease resistant to conventional therapy , aggressive strategies employing high dose chemoradiotherapy and auto logous stem cell transplant appear to be warranted. Support for this a pproach comes from animal studies employing marrow transplantation, wh ich have shown promising results. Likewise, longterm control of autoim mune disease has been demonstrated in some survivors of allogeneic tra nsplants for malignancy who incidentally had preexisting autoimmune di sease. Initial strategies for autografting will use intensive transpla nt regimens incorporating cyclophosphamide with or without total body irradiation. Peripheral blood stem cell grafts purified by CD34 select ion will be depleted of lymphocytes, and lead to rapid hematologic rec onstitution after treatment. Close monitoring for disease responses, a dverse effects of intensive immunosuppression, and longterm sequelae o f high dose therapies will be required. Initial studies are best perfo rmed as close collaborations between rheumatologists and transplant sp ecialists in appropriate research centers.