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Improving safety of autologous haematopoietic stem cell transplantation in patients with Crohn's disease
  1. Aranzazu Jauregui-Amezaga1,
  2. Montserrat Rovira2,
  3. Pedro Marín3,
  4. Azucena Salas1,
  5. Susana Pinó-Donnay1,
  6. Faust Feu1,
  7. J Ignasi Elizalde1,
  8. Francesc Fernández-Avilés2,
  9. Carmen Martínez2,
  10. Gonzalo Gutiérrez2,
  11. Laura Rosiñol2,
  12. Enric Carreras2,
  13. Alvaro Urbano2,
  14. Miguel Lozano3,
  15. Joan Cid3,
  16. María Suárez-Lledó2,
  17. Josep Mensa4,
  18. Jordi Rimola5,
  19. Sonia Rodríguez5,
  20. Mari Carme Masamunt1,
  21. Dolors Comas1,
  22. Irene Ruíz2,
  23. Anna Ramírez-Morros1,
  24. Marta Gallego1,
  25. Ingrid Ordás1,
  26. Julian Panés1,
  27. Elena Ricart1
  1. 1Gastroenterology Department, Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Barcelona, Spain
  2. 2Hematology Department, Hospital Clínic de Barcelona, Barcelona, Spain
  3. 3Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain
  4. 4Infectious Diseases Department, Hospital Clinic de Barcelona, Barcelona, Spain
  5. 5Radiology Department, Hospital Clínic de Barcelona, Barcelona, Spain
  1. Correspondence to Dr Elena Ricart, Gastroenterology Department—Hospital Clínic de Barcelona, IDIBAPS, CIBERehd, Villarroel 170, Barcelona 08036, Spain; ericart{at}clinic.ub.es

Abstract

Objective To evaluate the feasibility and toxicity of autologous haematopoietic stem cell transplantation (HSCT) for the treatment of refractory Crohn's disease (CD).

Design In this prospective study, patients with refractory CD suffering an aggressive disease course despite medical treatment, impaired quality of life and in whom surgery was not an acceptable option underwent HSCT. Toxicity and complications during the procedure and within the first year following transplantation were evaluated, along with the impact of the introduction of supportive measures on safety outcomes.

Results 26 patients were enrolled. During mobilisation, 16 patients (62%) presented febrile neutropaenia, including one bacteraemia and two septic shocks. Neutropaenia median time after mobilisation was 5 days. 5 patients withdrew from the study after mobilisation and 21 patients entered the conditioning phase. Haematopoietic recovery median time for neutrophils (>0.5×109/L) was 11 days and for platelets (>20×109/L) 4 days. Twenty patients (95%) suffered febrile neutropaenia and three patients (27%) presented worsening of the perianal CD activity during conditioning. Among non-infectious complications, 6 patients (28.5%) presented antithymocyte globulin reaction, 12 patients (57%) developed mucositis and 2 patients (9.5%) had haemorrhagic complications. Changes in supportive measures over the study, particularly antibiotic prophylaxis regimes during mobilisation and conditioning, markedly diminished the incidence of severe complications. During the first 12-month follow-up, viral infections were the most commonly observed complications, and one patient died due to systemic cytomegalovirus infection.

Conclusions Autologous HSCT for patients with refractory CD is feasible, but extraordinary supportive measures need to be implemented. We suggest that this procedure should only be performed in highly experienced centres.

  • CROHN'S DISEASE
  • INFLAMMATORY BOWEL DISEASE
  • BONE MARROW TRANSPLANTATION
  • IBD CLINICAL
  • IMMUNOLOGY

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