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High dose chemotherapy and syngeneic stem cell transplantation in a patient with refractory rheumatoid arthritis: poor response associated with persistence of host autoantibodies and synovial abnormalities
  1. M van Oosterhout1,
  2. R J Verburg1,
  3. E W N Levarht1,
  4. J D Moolenburgh2,
  5. R M Barge3,
  6. W E Fibbe3,
  7. J M van Laar1
  1. 1Department of Rheumatology, Leiden University Medical Centre, The Netherlands
  2. 2Department of Rheumatology, Medical Centre Alkmaar, The Netherlands
  3. 3Department of Haematology, Leiden University Medical Centre, The Netherlands
  1. Correspondence to:
    Dr J M van Laar
    Department of Rheumatology, Leiden University Medical Centre, PO Box 9600, 2300 RC Leiden, The Netherlands; J.M.van_LaarLUMC.nl

Abstract

Background: Immunoablative therapy combined with haematopoietic stem cell transplantation (SCT) is a possible treatment for patients with severe rheumatoid arthritis (RA).

Case report: A patient with rheumatoid factor positive, progressively erosive RA, refractive to treatment, was treated with high dose cyclophosphamide, followed by reinfusion of an unmanipulated peripheral blood graft derived from her identical twin sister. The clinical response was unsatisfactory, necessitating reinstitution of treatment with disease modifying antirheumatic drugs, which was associated with persistence of host serum autoantibodies and a cellular infiltrate in synovium, notably of plasma cells.

Discussion: The effectiveness of syngeneic SCT may be critically dependent on the degree of immunoablation achieved or on the composition of the graft.

  • CCP, cyclic citrullinated peptide
  • DMARDs, disease modifying antirheumatic drugs
  • G-CSF, granulocyte-colony stimulating factor
  • IV, intravenously
  • RA, rheumatoid arthritis
  • RF, rheumatoid factor
  • SCT, stem cell transplantation
  • rheumatoid arthritis
  • syngeneic transplantation
  • high dose chemotherapy

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