New therapeutic aspects: haemopoietic stem cell transplantation

Primary systemic vasculitis responds well to intensive immunosuppression, p articularly with cyclophosphomide. Use of the latter is restricted by side- effects, particularly in relapsing disease. Techniques which allow more com plete immunosuppression have an obvious attraction in autoimmune disease. T hey are particularly suitable for vasculitis which can go into long-lasting remission even with standard therapy in many cases. The conditioning used for stem cell transplantation allows more complete deletion of auto aggress ive T-cell clones, with subsequently haemopoietic rescue by previously harv ested stem cell precursors. The procedure also has immune potentiating effe cts, perhaps by promoting peripheral suppressor mechanisms. These may be im portant even though immune ablation is not achieved. With rigorous patient selection, experience with this technique in vasculitis may be broadened.