Immunoablation and haemopoietic stem cell transplantation for severe autoimmune disease with special reference to systemic lupus erythematosus.

Internationally 397 patients (310 in Europe/Austalasia and 87 in North America) with severe autoimmune disease (AD) have received an autologous haemopoietic stem cell transplant (HSCT) following immunoablation, 32 with systemic lupus erythematosus (SLE). The 23 in the EBMT/EULAR database mostly received cyclophosphamide (Cy) and G-CSF as mobilisation followed by Cy and antithymocyte globulin (ATG) conditioning. Nineteen improved with five relapses (mostly mild to moderate) and there were three procedure-related mortalities. In the Chicago series, nine patients were entered, seven improved, one died following mobilisation and one from active disease 3 months after mobilisation. Randomised, prospective controlled phase III trials are desired, but by consensus, more phase I and II data is required to plan the optimal protocol.