Autologous Hematopoietic Stem Cell Transplantation for Refractory Lupus Nephritis

Abstract

Background and objectives: Our study evaluated the efficiency and safety of autologous hematopoietic stem cell transplantation treatment for patients with refractory lupus nephritis.

Design, setting, participants, & measurements: From July 2011 to January 2015, a total of 22 patients with refractory lupus nephritis were enrolled in this study. Peripheral blood stem cells were mobilized with cyclophosphamide and granulocyte colony stimulating factor and reinfused after treatment with cyclophosphamide and antithymocyte globulin. The primary end point was the rate of remission, and secondary end points included the survival and relapse rates, changes in proteinuria, kidney function, and serology immunologic test. All complications were recorded for safety assessment.

Results: Twenty-two patients were enrolled and underwent stem cell mobilization. There were nine men and 13 women, with a median lupus nephritis duration of 46 (33-71) months. The mean number of CD34⁺ cells was (7.3±3.8)×10⁶/kg. All patients had successful engraftment, and the median times of granulocyte and platelet engraftment were 8 (7-9) and 9 (6-10) days, respectively. The major complications of stem cell transplantation were fever and gastrointestinal tract symptoms. The treatment-related mortality was 5% (one of 22). After a median follow-up of 72 (60-80) months, 18 (82%) patients achieved completed remission, one (5%) patient achieved partial remission, and one patient had no response and received peritoneal dialysis at 12 months after transplantation. The 5-year overall survival and disease-free survival rates were 91% and 53%, respectively. Six patients experienced relapse during the follow-up, and the relapse rate was 27%.

Conclusions: Autologous hematopoietic stem cell transplant could be used as a treatment option for refractory lupus nephritis, because it was relatively safe and associated with good outcomes.

Keywords: Antilymphocyte Serum; Autologous; Blood Platelets; Cyclophosphamide; Disease-Free Survival; Gastrointestinal Tract; Granulocyte Colony-Stimulating Factor; Granulocytes; Hematopoietic Stem Cell Mobilization; Hematopoietic Stem Cell Transplantation; Immunologic Tests; Peripheral Blood Stem Cells; Recurrence; Transplantation; efficacy; lupus nephritis; peritoneal dialysis; proteinuria; refractory.