International Journal of Hematology and Oncology
2023, Vol 33, Num 4 Page(s): 054-060
HEMATOPOIETIC STEM CELL TRANSPLANTATION IN AUTOIMMUNE DISEASES
HAKAN GÖKER1, BERNA GÖKER1
Hacettepe University Hospital Department of Internal Medicine
Keywords: autoimmune, transplantation, stem cell
Autoimmune diseases (ADs) affect many patients, leading to significant morbidity, cost of care and mortality. Conventional therapeutic manipulation of the immune system controls the majority of ADs to a certain extent, but there are some difficult to treat cases of refractory/relapsing, treatment-resistant ADs for which the term "malignant autoimmunity"has appropriately been suggested 3. If autoimmune disease is the result of reactivity against self, eradication of the cells involved in that reaction is anticipated to cure the disease. Patho-biologic basis of autoimmune diseases provide a rationale for a intense immunosuppression ("immuno-ablation"), followed by allogeneic or autologous hematopoietic stem cell (HSC) transplantation. Hence, pilot clinical studies of intense immuno-ablation with autologous HSC transplantation in severe ADs have been initiated in early '90s. Autologous peripheral blood stem cell transplants are used more frequently than allogeneic transplants mainly due to the greater safety of autologous transplantation. Initial pilot trials showed that HSC transplantation is a promising approach to treat autoimmune diseases and performed worldwide. Long-term clinical remissions rather than cures have been observed. However, randomized controlled trials are needed to elucidate the role of HSC transplantation in ADs.
HAKAN GÖKER1, BERNA GÖKER1
Hacettepe University Hospital Department of Internal Medicine
Keywords: autoimmune, transplantation, stem cell
Autoimmune diseases (ADs) affect many patients, leading to significant morbidity, cost of care and mortality. Conventional therapeutic manipulation of the immune system controls the majority of ADs to a certain extent, but there are some difficult to treat cases of refractory/relapsing, treatment-resistant ADs for which the term "malignant autoimmunity"has appropriately been suggested 3. If autoimmune disease is the result of reactivity against self, eradication of the cells involved in that reaction is anticipated to cure the disease. Patho-biologic basis of autoimmune diseases provide a rationale for a intense immunosuppression ("immuno-ablation"), followed by allogeneic or autologous hematopoietic stem cell (HSC) transplantation. Hence, pilot clinical studies of intense immuno-ablation with autologous HSC transplantation in severe ADs have been initiated in early '90s. Autologous peripheral blood stem cell transplants are used more frequently than allogeneic transplants mainly due to the greater safety of autologous transplantation. Initial pilot trials showed that HSC transplantation is a promising approach to treat autoimmune diseases and performed worldwide. Long-term clinical remissions rather than cures have been observed. However, randomized controlled trials are needed to elucidate the role of HSC transplantation in ADs.