Intense immunosuppression followed by purified blood CD34+ cell autografting in a patient with refractory juvenile rheumatoid arthritis

Bone Marrow Transplant. 2001 Feb;27(3):333-6. doi: 10.1038/sj.bmt.1702781.

Abstract

A 15-year-old boy with refractory juvenile rheumatoid arthritis (JRA) underwent intense immunosuppressive therapy followed by purified blood CD34+ cell autografting. He had been taking prednisolone (PDN) daily or every other day combined with methotrexate once a week to control the disease for 7 years. He suffered from psychological complications and a very short stature due to the adverse effects of these drugs. CD34+ cells were purified in bulk from G-CSF-mobilized PBSC using an Isolex 300. After the administration of cyclophosphamide (200 mg/kg) and anti-lymphocyte globulin (45 mg/kg), 3.6 x 10(6)/kg purified CD34+ cells were infused. His post-transplant course was uneventful except for herpes-zoster infection. He is now more than 1 year post transplant and has not taken any immunosuppressive medication. His rate of growth has increased (>10 cm/year) due to the effects of the cessation of PDN and the administration of recombinant human growth hormone (rGH), in contrast to the gain of 2 cm in the preceding 3 years with rGH treatment. Although the durability of this remission is unknown, intense immunosuppressive therapy followed by purified blood CD34+ cell autografting might be acceptable for adolescent patients with refractory JRA to achieve a drug-free period for physical and psychological maturation.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Antigens, CD34*
  • Antilymphocyte Serum / administration & dosage
  • Arthritis, Juvenile / immunology*
  • Arthritis, Juvenile / therapy*
  • Body Weight
  • Cell Separation / methods
  • Cyclophosphamide / administration & dosage
  • Disease-Free Survival
  • Hematopoietic Stem Cell Transplantation / methods*
  • Hematopoietic Stem Cells / cytology
  • Hematopoietic Stem Cells / immunology
  • Humans
  • Immunosuppression / methods*
  • Male
  • Quality of Life
  • Transplantation, Autologous / methods

Substances

  • Antigens, CD34
  • Antilymphocyte Serum
  • Cyclophosphamide