Control of severe systemic lupus erythematosus after high-dose immunosuppressive therapy and transplantation of CD34+purified autologous stem cells from peripheral blood

A 35 y old woman with severe and progressive systemic lupus erythematosus ( SLE received high-dose chemotherapy followed by a T cell depleted autologou s stem cell transplantation. Peripheral blood stem cell were mobilised with Cyclophosphamide 4.5 g/m(2) followed by Granulocyte-Colony Stimulating Fac tor (G-CSF). A CD34 positive selection provided a 3 log T cell depletion. H igh-dose immunosuppression consisted of the BEAM regimen. The purified auto graft was reinfused on day 0. In the post transplant period, hemopoietic gr owth factors, G-CSF, Granulocyte-Macrophage Colony Stimulating Factor (GM-C SF) and Erythropoietin, were administered, engraftment was rapid. Both the mobilisation and the transplant procedures were easily performed and well t olerated. One year later, the patient is in clinical remission. The ANA and anti-SSA-antibodies were undetectable at 1 and 6 months after intensificat ion, but reappeared at low levels at 9 months. Corticosteroid requirement h as gradually decreased. In conclusion, we report here the favourable evolut ion of a patient with a severe SLE, who clinically improved with high-dose immunosuppressive therapy and autologous stem cell transplantation, and sho wed a 9 month serological remission.