Intense immunosuppression followed by purified blood CD34(+) cell autografting in a patient with refractory juvenile rheumatoid arthritis

A 15-year-old boy with refractory juvenile rheumatoid arthritis (JRA) under went intense immunosuppressive therapy followed by purified blood CD34(+) c ell autografting, He had been taking prednisolone (PDN) daily or every othe r day combined with methotrexate once a week to control the disease for 7 y ears. He suffered from psychological complications and a very short stature due to the adverse effects of these drugs. CD34(+) cells were purified in bulk from G-CSF-mobilized PBSC using an Isolex 300, After the administratio n of cyclophosphamide (200 mg/kg) and anti-lymphocyte globulin (45 mg/kg), 3.6 x 106/kg purified CD34+ cells were infused. His post-transplant course was uneventful except for herpes-tester infection. He is now more than 1 ye ar post transplant and has not taken any immunosuppressive medication. His rate of growth has increased (>10 cm/year) due to the effects of the cessat ion of PDN and the administration of recombinant human growth hormone (rGH) , in contrast to the gain of 2 cm in the preceding 3 years with rGH treatme nt, Although the durability of this remission is unknown, intense immunosup pressive therapy followed by purified blood CD34+ cell autografting might b e acceptable for adolescent patients with refractory JRA to achieve a drug- free period for physical and psychological maturation.