Collection of hematopoietic stem cells from patients with autoimmune diseases

We reviewed data from 24 transplant centers in Asia, Australia, Europe, and North America to determine the outcomes of stem cell collection including methods used, cell yields, effects on disease activity, and complications i n patients with autoimmune diseases. Twenty-one unprimed bone marrow harves ts and 174 peripheral blood stem cell mobilizations were performed on 187 p atients. Disease indications were multiple sclerosis (76 patients), rheumat oid arthritis (37 patients), scleroderma (26 patients), systemic lupus eryt hematosus (19 patients), juvenile chronic arthritis (13 patients), idiopath ic autoimmune thrombocytopenia (8 patients), Behcet's disease (3 patients), undifferentiated vasculitis (3 patients), polychondritis (1 patient) and p olymyositis (1 patient). Bone marrow harvests were used in the Peoples Repu blic of China and preferred worldwide for children. PBSC mobilization was t he preferred technique for adult stem cell collection in America, Australia , and Europe. Methods of PBSC mobilization included G-CSF (5, 10, or 16 mug /kg/day) or cyclophosphamide (2 or 4 g/m(2)) with either G-CSF (5 or 10 mug /kg/day) or GM-CSF (5 mug/kg/day). Bone marrow harvests were without compli cations and did not affect disease activity. A combination of cyclophospham ide and G-CSF was more likely to ameliorate disease activity than G-CSF alo ne (P < 0.001). G-CSF alone was more likely to cause disease exacerbation t han the combination of cyclophosphamide and G-CSF (P = 0.003). Three patien ts died as a result of cyclophosphamide-based stem cell collection (2.6% of patients mobilized with cyclophosphamide). When corrected for patient weig ht and apheresis volume, progenitor cell yields tended to vary by underlyin g disease, prior medication history and mobilization regimen. Trends in the approaches to, and results of, progenitor cell mobilization are suggested by this survey. While cytokine-based mobilization appears less toxic, it is more likely to result in disease reactivation. Optimization with regard to cell yields and safety are likely to be disease-specific and prospective d isease-specific studies of mobilization procedures appear warranted.