Stem Cell Transplant

Syngeneic Blood Stem-Cell Transplant Yields Long-Term Remission in
Rheumatoid Arthritis Patient

WESTPORT, Oct 12 (Reuters Health) - In a man with severe treatment-resistant rheumatoid arthritis, high-dose chemotherapy and transplantat ion of hemopoietic stem cells from an identical twin have resulted in long-term remission, according to a report in the October
5th issue of Annals of Internal Medicine.

Dr. Geoff McColl, of The Royal Melbourne Hospital in Victoria, Australia, and associates there and at Tokyo Medical and Dental University in Japan treated a 39-year-old man who had experienced symptoms of severe seronegative rheumatoid arthritis for 7 years. His
identical twin brother was disease-free.

Before the stem-cell graft, the patient was given 50 mg/kg cyclophosphamide intravenously each day for 4 days and 30 mg/kg antithymocyte globulin per day for 3 days. One day after completion of
the preconditioning chemotherapy, CD34+ cells were transplanted from the donor to his brother.

The patient developed a skin rash and fever 7 days after the transplant and was treated with ceftazidime and vancomycin. He was released from
the hospital 2 weeks after the transplant and returned to normal activity within 6 weeks. Two years after the procedure, the patient required no treatment, had no joint swelling or tenderness, fever or other systemic symptoms, and was very physically active.

A polymerase chain reaction ELISA revealed that the patient's peripheral blood T-cell repertoires, which differed from the donor's before the
transplant, were identical to the donor's 16 weeks after transplantation, the researchers report.

"Our results suggest that long-term remissions achieved by use of this strategy will correlate with fundamental changes in the T-cell compartment, rather than the transient, immunosuppressive effects of high-dose chemotherapy," they write.

Ann Intern Med 1999;131:507-509.

Copyright � 1994-1999 by Medscape Inc.

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