Background

Intensive myelosuppressive or myeloablative chemotherapy followed by transplantation of stem cells derived directly from the bone marrow or from peripheral blood after suitable conditioning, has revolutionised the management of haematological malignancy and haemoglobinopathies. Because these manoeuvres cause significant and prolonged alterations in the body's immune system and function, stem cell transplantation has, in recent years, been used for severe cases of diseases that are believed to have an autoimmune basis. These diseases have included systemic sclerosis and multiple sclerosis but also rheumatoid arthritis, systemic lupus erythematosis, vasculitis, juvenile rheumatoid arthritis, and myasthenia gravis.1-7

Stem cell transplantation can either be allogeneic (from a donor, usually a HLA matched sibling) or autologous10 11(harvested from the individual undergoing treatment with later reinfusion). Syngeneic transplantation (from an identical twin) is also possible. Because of the higher mortality of allogeneic transplantation, most human experience is with autologous transplants. Data are still uncontrolled but there is growing evidence of benefit in the main conditions that have been treated (including systemic sclerosis and multiple sclerosis).12-17 Hitherto, selection …