Autologous stem cell transplantation for rheumatoid arthritis - Interim report of 6 patients

We assessed the safety and efficacy of autologous stem cell transplantation (ASCT) using T cell depleted grafts in the treatment of severe rheumatoid arthritis. Methods included mobilization 2 g/m(2) cyclophosphamide (Cy) and granulocyte-colony stimulating factor; graft manipulation of positive CD34 + and negative T cell selection: and conditioning by 200 mg/kg Cy. All 6 pa tients improved according to American College of Rheumatology response crit eria (one patient ACR70, 2 ACR50, 3 ACR20), but relapsed at 1.5-9 months wh en they began cyclosporine A (CSA). Five improved (one patient ACR remissio n, 2 ACR70, one ACR50, one improved but did not satisfy ACR response criter ia). No serious complications occurred during ASCT or up to 30 months' foll owup. There was prolonged reduction in CD4+ T cells. ASCT is safe and has s hort term efficacy. T cell purging does not prevent relapse. Five patients responded to CSA when their disease had previously been refractory, suggest ing an immunomodulatory effect. No serious infectious complications occurre d despite prolonged reduction in CD3+CD4+ lymphocytes.