PT  - JOURNAL ARTICLE
AU  - S Z Pavletic
AU  - J R Odell
AU  - S J Pirruccello
AU  - M M Ursick
AU  - C E Haire
AU  - J G Sharp
AU  - A Kessinger
AU  - L W Klassen
TI  - Intensive immunoablation and autologous blood stem cell transplantation in patients with refractory rheumatoid arthritis: the University of Nebraska experience.
DP  - 2001 Oct 01
TA  - The Journal of Rheumatology
PG  - 13--20
VI  - 64
4099  - http://www.jrheum.org/content/64/13.short
4100  - http://www.jrheum.org/content/64/13.full
SO  - J Rheumatol2001 Oct 01; 64
AB  - Two patients with severe rheumatoid arthritis (RA) were treated with high dose chemotherapy and autologous blood stem cell transplantation. Hematopoietic stem cells mobilized readily with cyclophosphamide and granulocyte-colony stimulating factor. Both patients achieved an American College of Rheumatology (ACR) 50% response before starting high dose therapy. The transplantation regimen included 200 mg/kg cyclophosphamide and 6 doses of equine antithymocyte globulin. Transplantation was well tolerated and both patients recovered neutrophils on day 7 post-transplant. At one month post-transplant both patients had an ACR response of 80%. Both individuals relapsed at 6 months and responded well to a combination of disease modifying antirheumatic drugs that was previously ineffective. At 12 months ACR responses were 80% and 60%, respectively. The first patient developed a flare at 18 months when she was found to be hypothyroid; she regained an 80% ACR response at 24 months with therapy of hypothyroidism. The second patient progressed relentlessly 15 months post-transplant. Immunological reconstitution showed a continuous inversion of the ratio of CD4 and CD8 lymphocytes with a predominant expansion of memory T cells.