Treatment of relapse after autologous blood stem cell transplantation for severe rheumatoid arthritis

There is little information about the clinical course of patients with rheu matoid arthritis (RA) who relapse after autologous blood stem cell transpla ntation (ASCT). We describe 6 patients with severe RA who received ASCT in 3 US centers. Duration of followup was between 24 and 42 months posttranspl ant. Five patients achieved major responses but relapsed 3-22 months posttr ansplant, Two patients with relapse improved remarkably after restarting di sease modifying antirheumatic drugs (DMARD). Two patients developed a mild RA flare at 3 and 5 months posuransplant and improved spontaneously. All 4 patients who improved after an initial disease flare remained highly functi onal at 14-22 months posttransplant. All patients in this study were anti-t umor necrosis factor (TNF) drug naive; all received a TNF blocker as a seco nd line posttransplant salvage therapy, but only 3 responded. Future ASCT s trategies need to focus on improving the durability of the early posttransp lant responses.