Peripheral blood stem cell transplantation for rheumatoid arthritis - Australian experience

Trials of high dose immunosuppression and peripheral blood stein cell trans plantation (PBSCT) in patients with severe rheumatoid arthritis (RA) have n ow commenced based on encouraging data from case reports of patients with c oexistent malignancy and animal transplant models. Early case reports in Au stralia documented the potential for cure of RA in most patients receiving allogeneic or syngeneic transplants. However, the relatively high morbidity and mortality of these procedures has necessitated the use of autologous P BSCT, in accordance with international guidelines released by the EBMT/EULA R working party. Phase I trials in autologous PBSCT have seen substantial r emissions of RA in the majority of patients who had previously failed all a vailable therapies. Recurrence of disease occurs in most patients usually w ithin 2 years; however, the use of disease modifying agents after recurrenc e results in substantial amelioration of the disease, again suggesting a fo rm of "immunomodulation." This observation raises the possibility of mainte nance therapy associated with procedure to prolong responses. Other modific ations of the procedure are discussed, including T cell depletion of the gr aft, currently the subject of a randomized trial.