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Autografting

Auto-SCT in refractory celiac disease type II patients unresponsive to cladribine therapy

Bone Marrow Transplantation volume 46, pages 840–846 (2011)Cite this article

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Abstract

Autologous hematopoietic SCT (auto-SCT) has been effective therapy for refractory disease, in both malignancies and severe autoimmune diseases. It seems feasible and safe for refractory celiac disease (RCD) type II, although long-term results have not been evaluated yet. With current therapies, progression into enteropathy-associated T-cell lymphoma (EATL) occurs in 60–80% patients, with a high mortality rate. Therefore, it is important to evaluate new treatment strategies. Between March 2004 and February 2010, 18 RCD II patients were evaluated for auto-SCT preceded by conditioning with fludarabine and melphalan, as a consequence of unresponsiveness to cladribine therapy. Adverse events, survival rate, EATL development and change in clinical, histological and immunological course were monitored. Thirteen patients were transplanted successfully and followed up for >2 years, 4-year survival rate was 66%. Only one patient died because of transplant-related complications. The majority of patients showed an impressive clinical improvement and five a complete histological remission. In five patients, auto-SCT could not be performed; they all died with a median survival of 5.5 months. EATL was observed in one transplanted patient, only after 4 years of follow-up. Auto-SCT after conditioning with high-dose chemotherapy in RCD II patients unresponsive to cladribine therapy is feasible and seems promising.

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Acknowledgements

This study was supported by an unrestricted grant from AstraZeneca. There was no affiliation potentially able to introduce a bias.

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Authors and Affiliations

  1. Department of Gastroenterology and Hepatology, VU University Medical Center, Amsterdam, The Netherlands

    G J Tack, W H M Verbeek & C J J Mulder

  2. Department of Hematology, VU University Medical Center, Amsterdam, The Netherlands

    M J Wondergem, G J Ossenkoppele, P C Huijgens & O J Visser

  3. Department of Gastroenterology and Hepatology, Sint Antonius hospital, Nieuwegein, The Netherlands

    A Al-Toma

  4. Department of Medicine IV, Charité-University Medicine, Berlin, Germany

    A Schmittel

  5. Department of Hematology and Oncology, Charité-University Medicine, Berlin, Germany

    A Schmittel

  6. Department of Gastroenterology and Hepatology, Santa Maria hospital, Lisbon, Portugal

    M V Machado

  7. Department of Gastroenterology and Digestive Endoscopy, ‘Madonna del Soccorso’ Hospital, San Benedetto del Tronto, Italy

    F Perri

  8. Department of Clinical Pathology, VU University Medical Center, Amsterdam, The Netherlands

    M W J Schreurs

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  1. G J Tack
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Correspondence to G J Tack.

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Tack, G., Wondergem, M., Al-Toma, A. et al. Auto-SCT in refractory celiac disease type II patients unresponsive to cladribine therapy. Bone Marrow Transplant 46, 840–846 (2011). https://doi.org/10.1038/bmt.2010.199

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