Stem Cell Transplantation in Autoimmune Disease

International Journal of Hematology

, Volume 76, Issue 1, pp 226-247

Induction of tolerance in autoimmune diseases by hematopoietic stem cell transplantation: Getting closer to a cure?

  • Richard K. BurtAffiliated withDivision of Immune Therapy and Autoimmune Disease, Northwestern University Medical Center
  • , Shimon SlavinAffiliated withDepartment of Bone Marrow Transplantation & Cancer Immunotherapy, Hadassah University Hospital
  • , William H. BurnsAffiliated withBone Marrow Transplantation, Medical College of Wisconsin
  • , Alberto M. MarmontAffiliated withDivisione di Ematologia II, Centro Trapianti di Midollo Osseo, Azienda Ospedaliera S. Martino

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Abstract

Hematopoietic stem cells (HSCs) are the earliest cells of the immune system, giving rise to B and T lymphocytes, monocytes, tissue macrophages, and dendritic cells. In animal models, adoptive transfer of HSCs, depending on circumstances, may cause, prevent, or cure autoimmune diseases. Clinical trials have reported early remission of otherwise refractory autoimmune disorders after either autologous or allogeneic hematopoietic stem cell transplantation (HSCT). By percentage of transplantations performed, autoimmune diseases are the most rapidly expanding indication for stem cell transplantation. Although numerous editorials or commentaries have been previously published, no prior review has focused on the immunology of transplantation tolerance or development of phase 3 autoimmune HSCT trials. Results from current trials suggest that mobilization of HSCs, conditioning regimen, eligibility and exclusion criteria, toxicity, outcome, source of stem cells and posttransplantation follow-up need to be disase specific. HSCT-induced remission of an autoimmune disease allows for a prospective analysis of events involved in immune tolerance not available in cross-sectional studies. *** DIRECT SUPPORT *** A00RC002 00010