TY - JOUR T1 - Improving safety of autologous haematopoietic stem cell transplantation in patients with Crohn's disease JF - Gut JO - Gut SP - 1456 LP - 1462 DO - 10.1136/gutjnl-2015-309836 VL - 65 IS - 9 AU - Aranzazu Jauregui-Amezaga AU - Montserrat Rovira AU - Pedro Marín AU - Azucena Salas AU - Susana Pinó-Donnay AU - Faust Feu AU - J Ignasi Elizalde AU - Francesc Fernández-Avilés AU - Carmen Martínez AU - Gonzalo Gutiérrez AU - Laura Rosiñol AU - Enric Carreras AU - Alvaro Urbano AU - Miguel Lozano AU - Joan Cid AU - María Suárez-Lledó AU - Josep Mensa AU - Jordi Rimola AU - Sonia Rodríguez AU - Mari Carme Masamunt AU - Dolors Comas AU - Irene Ruíz AU - Anna Ramírez-Morros AU - Marta Gallego AU - Ingrid Ordás AU - Julian Panés AU - Elena Ricart Y1 - 2016/09/01 UR - http://gut.bmj.com/content/65/9/1456.abstract N2 - 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. ER -