ISSN: 1859 - 2872
Initial results of autologous hematopoietic stem cell transplantation for systemic lupus erythematosus in Vietnam
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Abstract
Objective: To report the initial efficacy of autologous hematopoietic stem cell transplantation (HSCT) in treatment of systemic lupus erythematosus. Subject and method: Four patients with systemic lupus erythematosus who responded poorly to conventional treatments were selected for autologous hematopoietic stem cell transplantation. Stem cells were mobilized from bone marrow to peripheral blood by Cyclophosphamide and G-CSF. Two patients received a transplant of CD34+ selective stem cells, while 2 other patients received a transplant of CD34+ non-selective stem cells. The conditioning protocol includes Rituximab, Cyclophosphamide and ATG (anti-thymocyte globulin). Evaluation and monitoring criteria include (1) Stem cell transplantation progress; (2) Disease activity level and post-transplant therapy status; (3) Autoimmune antibodies and immune cells; (4) The method's safety. Results: The age of patients at the time of HSCT ranged from 13 to 46 years. The male:female ratio is 1:1. Disease duration before transplantation was from 3 to 12 years. The lowest dose of CD34+ cells for transplantation was 4.09 × 106 cells/kg body weight, the highest was 7.93 × 106 cells/kg body weight. The recovery time for neutrophils above 500 cells/µL is 8 to 11 days. The time it takes for platelets to recover to levels above 50 × 103 cells/µL is 8 to 13 days. Hospital stay for HSCT ranges from 17 to 24 days; After transplantation, all corticosteroids and immunosuppressive drugs were discontinued; Clinical symptoms significantly improved (mean SLEDAI score decreased from 16.0 points to 4.5 points (1 month after transplant), 2.0 points (3 months after transplant), and 1.0 points (6 months after transplant). Proteinuria decrease as time passed, from 2.4g/l before transplant to 0.2g/l three and six months after transplant. Anti-dsDNA antibodies concentrations decreased from 95.2IU/mL on average to 24.9IU/mL (6 months post-transplant). Six months following HSCT, T lymphocytes, and B lymphocytes returned to near-normal levels. No infectious incidents occurred during the transplant. Fatigue, anorexia, nausea, vomiting, abdominal pain, diarrhea, and bone pain are temporary side effects. Conclusion: Initial results using autologous hematopoietic stem cell transplantation for systemic lupus erythematosus showed a marked improvement in clinical symptoms of the disease along with no need for medication; successfully applied in Vietnam.
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References
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