Article Text

PDF
Autologous haematopoietic stem cell transplantation without CD34+ cell selection in refractory Crohn’s disease
  1. A Cassinotti1,
  2. C Annaloro2,
  3. S Ardizzone1,
  4. F Onida2,
  5. A Della Volpe2,
  6. M Clerici1,
  7. P Usardi2,
  8. S Greco1,
  9. G Maconi1,
  10. G Bianchi Porro1,
  11. G Lambertenghi Deliliers2
  1. 1
    Department of Clinical Science, “L. Sacco” University Hospital, Milan, Italy
  2. 2
    Bone Marrow Transplantation Centre, Fondazione Ospedale Maggiore Policlinico, Mangiagalli e Regina Elena, University of Milan, Italy
  1. Dr Andrea Cassinotti, Chair of Gastroenterology, “L. Sacco” University Hospital, via G.B. Grassi 74, 20157 Milan, Italy; andreacassinotti{at}libero.it

Abstract

Objectives: Autologous haematopoietic stem cell transplantation (HSCT) with CD34+ cell selection has recently been used in the treatment of refractory Crohn’s disease, showing good safety and promising efficacy. We investigated the safety and efficacy of HSCT with unselected peripheral blood stem cells (PBSCs) in moderate–severe refractory Crohn’s disease.

Patients: Four patients (three male, one female; age range 26–45 years) with active moderate–severe Crohn’s disease (median Crohn’s Disease Activity Index (CDAI) 319, range 272–345), refractory or intolerant to multiple drugs including infliximab, were enrolled.

Interventions: Unselected PBSCs were collected after mobilisation with cyclophosphamide (CTX) 1.5 g/m2 and granulocyte-colony stimulating factor (G-CSF) 10 μg/kg. The conditioning regimen included CTX 50 mg/kg on days −5 to −2 and rabbit anti-thymocyte globulin (ATG) 2.5 mg/kg on days −4 to −2.

Main outcome measures: Primary endpoints were toxicity and clinical remission (CDAI<150) at 3 months. Secondary endpoints were clinical and endoscopic response at 3 months and toxicity, clinical and endoscopic remission at 12 months.

Results: No improvement or slight deterioration was observed following mobilisation (median CDAI 339, range 258–404). At the third month, the primary endpoint of clinical remission was achieved in all patients, with a median CDAI of 91 (range 56–102), and complete endoscopic remission was achieved in 2/3 patients. After a median follow-up of 16.5 months, 3/4 patients maintained both clinical and endoscopic remission, despite withdrawal of all drugs, and complete fistula closure was observed in all affected patients. No deaths or life-threatening infection occurred. Unexpected adverse events included a perianal abscess after mobilisation in one patient, pleural and pericardial effusions in another and BK virus-related macrohaematuria in another, all rapidly resolved with conservative treatment.

Conclusion: Autologous HSCT with unselected PBSC appears to be safe and can induce and maintain remission in previously refractory Crohn’s disease patients.

Statistics from Altmetric.com

Footnotes

  • Funding: The research was supported by a grant from Ministero dell’Istruzione e della Ricerca Scientifica (MIUR), Protocol number 2004064901.

  • Competing interests: None.

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

Linked Articles

  • Digest
    Robin Spiller Magnus Simren