Skip to main content

Advertisement

Log in

Stem cell autograft and allograft in autoimmune diseases

  • Review Article
  • Published:
Clinical and Experimental Medicine Aims and scope Submit manuscript

Abstract

Autoimmune diseases are characterized by an insufficiency of immune tolerance and, although treated with a number of useful drugs, may need more unconventional therapeutic strategies for their more severe presentations. Among such unconventional therapeutic approaches, stem cell autograft and allograft have been used, with the aim of stimulating disease remission by modifying the pathogenic mechanisms that induce anomalous responses against self-antigens. Autologous transplantation is performed with the purpose of retuning autoimmune cells, whereas allogeneic transplantation is performed with the purpose of replacing anomalous immune effectors and mediators. In this article, we comprehensively review up-to-date information on the autoimmune diseases for which the transplantation of stem cells is indicated.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Similar content being viewed by others

References

  1. Atkins HL, Muraro PA, van Laar JM, Pavletic SZ. AHSCT for autoimmune disease—is it now ready for prime time? Biol Blood Marrow Transplant. 2012;18:177–283.

    Article  Google Scholar 

  2. Radbruch A, Thiel A. Cell therapy for autoimmune diseases: does it have a future? Ann Rheum Dis. 2004;63(Suppl 2):96–101.

    Google Scholar 

  3. Muraro PA, Douek DC, Packer A, et al. Thymic output generates a new and diverse TCR repertoire after autologous stem cell transplantation in multiple sclerosis patients. J Exp Med. 2005;201:805–16.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  4. Farge D, Henegar C, Carmagnat M, et al. Analysis of immune reconstitution after autologous bone marrow transplantation in systemic sclerosis. Arthritis Rheum. 2005;52:1555–63.

    Article  CAS  PubMed  Google Scholar 

  5. Alexander T, Thiel A, Rosen O, et al. Depletion of autoreactive immunologic memory followed by autologous hematopoietic stem cell transplantation in patients with refractory SLE induces long term remission through de novo generation of a juvenile and tolerant immune system. Blood. 2009;113:214–23.

    Article  CAS  PubMed  Google Scholar 

  6. Zhang L, Bertucci AM, Ramsey-Goldman R, Burt RK, Datta SK. Regulatory T cell (Treg) subsets return in patients with refractory lupus following stem cell transplantation, and TGF-beta-producing CD8+ Treg cells are associated with immunological remission of lupus. J Immunol. 2009;183:6346–58.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  7. Muraro P. Restoring self-tolerance: lessons from the clinic. Bone Marrow Transplant. 2010;45(1):S2.

    Google Scholar 

  8. Snowden JA, Saccardi R, Allez M, et al. Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2012;47:70–790.

    Article  Google Scholar 

  9. Saccardi R, Tyndall A, Coghlan G, et al. Consensus statement concerning cardiotoxicity occurring during haematopoietic stem cell transplantation in the treatment of autoimmune diseases, with special reference to systemic sclerosis and multiple sclerosis. Bone Marrow Transplant. 2004;34:877–81.

    Article  CAS  PubMed  Google Scholar 

  10. Gratwohl A, Passweg J, Bocelli-Tyndall C, et al. Autologous hematopoietic stem cell transplantation for autoimmune diseases. Bone Marrow Transplant. 2005;35:869–79.

    Article  CAS  PubMed  Google Scholar 

  11. Farge D, Labopin M, Tyndall A, et al. Autologous hematopoietic stem cell transplantation for autoimmune diseases: an observational study on 12 years’ experience from the European Group for Blood and Marrow Transplantation Working Party on Autoimmune Diseases. Haematologica. 2010;95:284–92.

    Article  PubMed  PubMed Central  Google Scholar 

  12. Compston A, Coles A. Multiple sclerosis. Lancet. 2008;372:1502–17.

    Article  CAS  PubMed  Google Scholar 

  13. Johnson KP, Brooks BR, Cohen JA, et al. Copolymer 1 reduces relapse rate and improves disability in relapsing–remitting multiple sclerosis: results of a phase III multicenter, double-blind placebocontrolled trial. The copolymer 1 multiple sclerosis study group. Neurology. 1995;45:1268–76.

    Article  CAS  PubMed  Google Scholar 

  14. Paty DW, Li DK. Interferon beta-1b is effective in relapsing remitting multiple sclerosis. II. MRI analysis results of a multicenter, randomized, double-blind, placebo-controlled trial. UBC MS/MRI study group and the IFNB multiple sclerosis study group. Neurology. 1993;43:662–7.

    Article  CAS  PubMed  Google Scholar 

  15. Gabrielli A, Avvedimento EV, Krieg T. Scleroderma. N Engl J Med. 2009;360:1989–2003.

    Article  CAS  PubMed  Google Scholar 

  16. Domsic RT, Rodriguez-Reyna T, Lucas M, Fertig N, Medsger TA Jr. Skin thickness progression rate: a predictor of mortality and early internal organ involvement in diffuse scleroderma. Ann Rheum Dis. 2011;70:104–9.

    Article  PubMed  Google Scholar 

  17. Ioannidis JP, Vlachoyiannopoulos PG, Haidich AB, et al. Mortality in systemic sclerosis: an international meta-analysis of individual patient data. Am J Med. 2005;118:2–10.

    Article  PubMed  Google Scholar 

  18. Scussel-Lonzetti L, Joyal F, Raynauld JP, et al. Predicting mortality in systemic sclerosis: analysis of a cohort of 309 French Canadian patients with emphasis on features at diagnosis as predictive factors for survival. Medicine (Baltimore). 2002;81:154–67.

    Article  Google Scholar 

  19. Tashkin DP, Elashoff R, Clements PJ, et al. Cyclophosphamide versus placebo in scleroderma lung disease. N Engl J Med. 2006;354:2655–66.

    Article  CAS  PubMed  Google Scholar 

  20. Nannini C, West CP, Erwin PJ, Matteson EL. Effects of cyclophosphamide on pulmonary function in patients with scleroderma and interstitial lung disease: a systematic review and meta-analysis of randomized controlled trials and observational prospective cohort studies. Arthritis Res Ther. 2008;10:R124.

    Article  PubMed  PubMed Central  Google Scholar 

  21. Binks M, Passweg JR, Furst D, et al. Phase I/II trial of autologous stem cell transplantation in systemic sclerosis: procedure related mortality and impact on skin disease. Ann Rheum Dis. 2001;60:577–84.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Farge D, Passweg J, van Laar JM, et al. Autologous stem cell transplantation in the treatment of systemic sclerosis: report from the EBMT/EULAR registry. Ann Rheum Dis. 2004;63:974–81.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  23. Farge D, Marolleau JP, Zohar S, et al. Autologous bone marrow transplantation in the treatment of refractory systemic sclerosis: early results from a French multicentre phase I–II study. Br J Haematol. 2002;119:726–39.

    Article  PubMed  Google Scholar 

  24. Burt RK, Oyama Y, Traynor A, et al. Hematopoietic stem cell transplantation for systemic sclerosis with rapid improvement in skin scores: is neoangiogenesis occurring? Bone Marrow Transplant. 2003;32(Suppl 1):S65–7.

    Article  CAS  PubMed  Google Scholar 

  25. McSweeney PA, Nash RA, Sullivan KM, et al. High-dose immunosuppressive therapy for severe systemic sclerosis: initial outcomes. Blood. 2002;100:1602–10.

    CAS  PubMed  PubMed Central  Google Scholar 

  26. Fiehn C, Hajjar Y, Mueller K, Waldherr R, Ho AD, Andrassy K. Improved clinical outcome of lupus nephritis during the past decade: importance of early diagnosis and treatment. Ann Rheum Dis. 2003;62:435–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  27. Gayed M, Gordon C. Novel treatments for systemic lupus erythematosus. Curr Opin Invest Drugs. 2010;11:1256–64.

    CAS  Google Scholar 

  28. Nossent J, Cikes N, Kiss E, et al. Current causes of death in systemic lupus erythematosus in Europe, 2000–2004: relation to disease activity and damage accrual. Lupus. 2007;16:309–17.

    Article  CAS  PubMed  Google Scholar 

  29. Doria A, Iaccarino L, Ghirardello A, et al. Long-term prognosis and causes of death in systemic lupus erythematosus. Am J Med. 2006;119:700–6.

    Article  PubMed  Google Scholar 

  30. Hampe J, Cuthbert A, Croucher PJ, et al. Association between insertion mutation in NOD2 gene and Crohn’s disease in German and British populations. Lancet. 2001;357:1925–8.

    Article  CAS  PubMed  Google Scholar 

  31. Jess T, Riis L, Jespersgaard C, et al. Disease concordance, zygosity, and NOD2/CARD15 status: follow-up of a population-based cohort of Danish twins with inflammatory bowel disease. Am J Gastroenterol. 2005;100:2486–92.

    Article  CAS  PubMed  Google Scholar 

  32. Kreisel W, Potthoff K, Bertz H, et al. Complete remission of Crohn’s disease after high-dose cyclophosphamide and autologous stem cell transplantation. Bone Marrow Transplant. 2003;32:337–40.

    Article  CAS  PubMed  Google Scholar 

  33. Oyama Y, Craig RM, Traynor AE, et al. Autologous hematopoietic stem cell transplantation in patients with refractory Crohn’s disease. Gastroenterology. 2005;128:552–63.

    Article  PubMed  Google Scholar 

  34. Cassinotti A, Annaloro C, Ardizzone S, et al. Autologous haematopoietic stem cell transplantation without CD34+ cell selection in refractory Crohn’s disease. Gut. 2008;57:211–7.

    Article  CAS  PubMed  Google Scholar 

  35. Burt RK, Craig RM, Milanetti F, et al. Autologous nonmyeloablative hematopoietic stem cell transplantation in patients with severe anti-TNF refractory Crohn disease: long-term follow-up. Blood. 2010;116:6123–32.

    Article  CAS  PubMed  Google Scholar 

  36. Duijvestein M, Vos AC, Roelofs H, et al. Autologous bone marrow-derived mesenchymal stromal cell treatment for refractory luminal Crohn’s disease: results of a phase I study. Gut. 2010;59(12):1662–9.

    Article  PubMed  Google Scholar 

  37. Ciccocioppo R, Bernardo ME, Sgarella A, et al. Autologous bone marrow-derived mesenchymal stromal cells in the treatment of fistulising Crohn’s disease. Gut. 2011;60(6):788–98.

    Article  PubMed  Google Scholar 

  38. Quartier P, Taupin P, Bourdeaut F, et al. Efficacy of etanercept for the treatment of juvenile idiopathic arthritis according to the onset type. Arthritis Rheum. 2003;48:1093–101.

    Article  CAS  PubMed  Google Scholar 

  39. Yokota S, Miyamae T, Imagawa T, et al. Therapeutic efficacy of humanized recombinant anti-interleukin-6 receptor antibody in children with systemic- onset juvenile idiopathic arthritis. Arthritis Rheum. 2005;52:818–25.

    Article  CAS  PubMed  Google Scholar 

  40. Bingham S, Griffiths B, McGonagle D, Snowden JA, Morgan G, Emery P. Autologous stem cell transplantation for rapidly progressive Jo-1-positive polymyositis with long-term followup. Br J Haematol. 2001;113:840–1.

    Article  CAS  PubMed  Google Scholar 

  41. Oryoji K, Himeji D, Nagafuji K, et al. Successful treatment of rapidly progressive interstitial pneumonia with autologous peripheral blood stem cell transplantation in a patient with dermatomyositis. Clin Rheumatol. 2005;24:637–40.

    Article  PubMed  Google Scholar 

  42. Tsukamoto H, Nagafuji K, Horiuchi T, et al. A phase I–II trial of autologous peripheral blood stem cell transplantation in the treatment of refractory autoimmune disease. Ann Rheum Dis. 2006;65:508–14.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  43. Holzer U, van Royen-Kerkhof A, van der Torre P, et al. Successful autologous stem cell transplantation in two patients with juvenile dermatomyositis. Scand J Rheumatol. 2010;39:88–92.

    Article  CAS  PubMed  Google Scholar 

  44. Daikeler T, Kötter I, Bocelli Tyndall C, et al. Haematopoietic stem cell transplantation for vasculitis including Behcet’s disease and polychondritis: a retrospective analysis of patients recorded in the European Bone Marrow Transplantation and European League Against Rheumatism databases and a review of the literature. Ann Rheum Dis. 2007;66:202–7.

    Article  PubMed  PubMed Central  Google Scholar 

  45. Keogh KA, Wylam ME, Stone JH, Specks U. Induction of remission by B lymphocyte depletion in eleven patients with refractory antineutrophil cytoplasmic antibody-associated vasculitis. Arthritis Rheum. 2005;52:262–8.

    Article  PubMed  Google Scholar 

  46. Kötter I, Daikeler T, Amberger C, Tyndall A, Kanz L. Autologous stem cell transplantation of treatment-resistant systemic vasculitis—a single center experience and review of the literature. Clin Nephrol. 2005;64:485–9.

    Article  PubMed  Google Scholar 

  47. Kunitomi A, Ishikawa T, Tajima K, Konaka Y, Yagita M. Bone marrow transplantation with a reduced-intensity conditioning regimen in a patient with Wegener granulomatosis and therapy-related leukemia. Int J Hematol. 2006;83:262–5.

    Article  PubMed  Google Scholar 

  48. Maurer B, Hensel M, Max R, Fiehn C, Ho AD, Lorenz HM. Autologous haematopoietic stem cell transplantation for Behcet’s disease with pulmonary involvement: analysis after 5 years of follow up. Ann Rheum Dis. 2006;65:127–9.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  49. Statkute L, Oyama Y, Barr WG, et al. Autologous non-myeloablative haematopoietic stem cell transplantation for refractory systemic vasculitis. Ann Rheum Dis. 2008;67:991–7.

    Article  CAS  PubMed  Google Scholar 

  50. Rossi G, Moretta A, Locatelli F. Autologous hematopoietic stem cell transplantation for severe/refractory intestinal Behcet disease. Blood. 2004;103(2):748–50.

    Article  CAS  PubMed  Google Scholar 

  51. Kook MH, Yhim HY, Lee NR, et al. Successful treatment of myelodysplastic syndrome and Behcet colitis after allogeneic hematopoietic stem cell transplantation. Korean J Intern Med. 2014;29:123–5.

    Article  PubMed  PubMed Central  Google Scholar 

  52. De Cata A, Intiso D, Bernal M, Molinaro F, Mazzoccoli G, D’Alessandro V, et al. Prolonged remission of neuro-Behcet’s disease following autologous transplantation. Int J Immunopathol Pharmacol. 2006;20:91–6.

    Google Scholar 

  53. Marmont AM, Gualandi F, Piaggio G, et al. Allogeneic bone marrow transplantation (BMT) for refractory Behcet’s disease with severe CNS involvement. Bone Marrow Transplant. 2006;37:1061–3.

    Article  CAS  PubMed  Google Scholar 

  54. Haghighi AB, Safari A. Proposing an algorithm for treatment of different manifestations of neuro-Behcet’s disease. Clin Rheumatol. 2010;29:683–6.

    Article  Google Scholar 

  55. Davatchi F, Nikbin B, Shams H, et al. Mesenchymal stem cell therapy unable to rescue the vision from advanced Behcet’s disease retinal vasculitis: report of three patients. Int J Rheumatic Dis. 2013;16:139–47.

    Article  CAS  Google Scholar 

  56. Daikeler T, Hügle T, Farge D, et al. Allogeneic hematopoietic SCT for patients with autoimmune diseases. Bone Marrow Transplant. 2009;44:27–33.

    Article  CAS  PubMed  Google Scholar 

  57. Pasquini MC, Griffith LM, Arnold DL, et al. Hematopoietic stem cell transplantation for multiple sclerosis: collaboration of the CIBMTR and EBMT to facilitate international clinical studies. Biol Blood Marrow Transplant. 2010;16:1076–83.

    Article  PubMed  PubMed Central  Google Scholar 

  58. Cooley HM, Snowden JA, Grigg AP, Wicks IP. Outcome of rheumatoid arthritis and psoriasis following autologous stem cell transplantation for hematologic malignancy. Arthritis Rheum. 1997;40:1712–5.

    Article  CAS  PubMed  Google Scholar 

  59. Marmont AM, van Lint MT, Gualandi F, Bacigalupo A. Autologous marrow stem cell transplantation for severe systemic lupus erythematosus of long duration. Lupus. 1997;6:545–8.

    Article  CAS  PubMed  Google Scholar 

  60. Burt RK, Traynor AE, Cohen B, et al. T cell–depleted autologous hematopoietic stem cell transplantation for multiple sclerosis: report on the first three patients. Bone Marrow Transplant. 1998;21:537–41.

    Article  CAS  PubMed  Google Scholar 

  61. Fassas A, Anagnostopoulos A, Kazis A, et al. Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first results of a pilot study. Bone Marrow Transplant. 1997;20:631–8.

    Article  CAS  PubMed  Google Scholar 

  62. Fassas A, Anagnostopoulos A, Kazis A, et al. Autologous stem cell transplantation in progressive multiple sclerosis—an interim analysis of efficacy. J Clin Immunol. 2000;20:24–30.

    Article  CAS  PubMed  Google Scholar 

  63. Kozák T, Havrdová E, Pit’ha J, et al. High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis. Bone Marrow Transplant. 2000;25:525–31.

    Article  PubMed  Google Scholar 

  64. Nash RA, Bowen JD, McSweeney PA, et al. High-dose immunosuppressive therapy and autologous peripheral blood stem cell transplantation for severe multiple sclerosis. Blood. 2003;102:2364–72.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  65. Carreras E, Saiz A, Marín P, et al. CD34+ selected autologous peripheral blood stem cell transplantation for multiple sclerosis: report of toxicity and treatment results at one year of follow-up in 15 patients. Haematologica. 2003;88:306–14.

    PubMed  Google Scholar 

  66. Saccardi R, Mancardi GL, Solari A, et al. Autologous HSCT for severe progressive multiple sclerosis in a multicenter trial: impact on disease activity and quality of life. Blood. 2005;105:2601–7.

    Article  CAS  PubMed  Google Scholar 

  67. Samijn JP, te Boekhorst PA, Mondria T, et al. Intense T cell depletion followed by autologous bone marrow transplantation for severe multiple sclerosis. J Neurol Neurosurg Psychiatr. 2006;77:46–50.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  68. Burt RK, Loh Y, Cohen B, et al. Autologous non-myeloablative haemopoietic stem cell transplantation in relapsing–remitting multiple sclerosis: a phase I/II study. Lancet Neurol. 2009;8:244–53.

    Article  CAS  PubMed  Google Scholar 

  69. Nash RA, McSweeney PA, Crofford LJ, et al. High-dose immunosuppressive therapy and autologous hematopoietic cell transplantation for severe systemic sclerosis: long-term follow-up of the US multicenter pilot study. Blood. 2007;110:1388–96.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  70. Oyama Y, Barr WG, Statkute L, et al. Autologous non-myeloablative hematopoietic stem cell transplantation in patients with systemic sclerosis. Bone Marrow Transplant. 2007;40:549–55.

    Article  CAS  PubMed  Google Scholar 

  71. Vonk MC, Marjanovic Z, van den Hoogen FH, et al. Long-term follow-up results after autologous haematopoietic stem cell transplantation for severe systemic sclerosis. Ann Rheum Dis. 2008;67:98–104.

    Article  CAS  PubMed  Google Scholar 

  72. Burt RK, Marmont A, Oyama Y, et al. Randomized controlled trials of autologous hematopoietic stem cell transplantation for autoimmune diseases: the evolution from myeloablative to lymphoablative transplant regimens. Arthritis Rheum. 2006;54:3750–60.

    Article  PubMed  Google Scholar 

  73. Snowden JA, Biggs JC, Milliken ST, Fuller A, Brooks PM. A phase I/II dose escalation study of intensified cyclophosphamide and autologous blood stem cell rescue in severe, active rheumatoid arthritis. Arthritis Rheum. 1999;42:2286–92.

    Article  CAS  PubMed  Google Scholar 

  74. Verburg RJ, Mahabali SD, Stiggelbout AM, Sont JK, van Laar JM. High dose chemotherapy and hematopoietic stem cell transplantation: a study of treatment preference in patients with rheumatoid arthritis and rheumatologists. J Rheumatol. 2002;29:1653–8.

    PubMed  Google Scholar 

  75. Moore J, Brooks P, Milliken S, et al. A pilot randomized trial comparing CD34-selected versus unmanipulated hemopoietic stem cell transplantation for severe, refractory rheumatoid arthritis. Arthritis Rheum. 2002;46:2301–9.

    Article  CAS  PubMed  Google Scholar 

Download references

Acknowledgments

The study was supported by the “5 × 1,000” voluntary contribution and by a Grant (GM) from the Italian Ministry of Health (RC1201ME04, RC1203ME46, RC1302ME31 and RC1403ME50) through Department of Medical Sciences, Division of Internal Medicine and Chronobiology Unit, IRCCS Scientific Institute and Regional General Hospital “Casa Sollievo della Sofferenza,” Opera di Padre Pio da Pietrelcina, San Giovanni Rotondo (FG), Italy. The authors would like to thank George Anderson of CRC Scotland & London for English editing services.

Conflict of interest

The authors declare that there are no conflicts of interest with respect to the authorship and/or publication of this article.

Author information

Authors and Affiliations

Authors

Corresponding authors

Correspondence to Angelo De Cata or Gianluigi Mazzoccoli.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

De Cata, A., Matarangolo, A., Inglese, M. et al. Stem cell autograft and allograft in autoimmune diseases. Clin Exp Med 16, 13–20 (2016). https://doi.org/10.1007/s10238-014-0330-5

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10238-014-0330-5

Keywords

Navigation