NEW YORK, Aug 28 (Praxis Press). Despite immunosuppressive and other therapies, the annual mortality rate of systemic lupus erythematosus (SLE) remains about one percent. Traynor and colleagues studied the effects of high-dose cyclophosphamide treatment and autologous, haematopoietic stem cell transplantation in nine patients with severe, steroid-dependent SLE. Two patients developed infections (cytomegalovirus and mucormycosis) after stem cell harvest and were excluded from the study; seven patients were able to complete transplantation with cells enriched by CD34-positive selection. After transplantation, neutrophil engraftment occurred within a median nine days, and platelet engraftment occurred within a median eleven days. Three patients remained on low-dose prednisone. All patients were free of SLE symptoms and laboratory evidence of disease at a median follow-up of 25 months; furthermore, T-cell phenotypes and function returned to normal. Stem cell transplantation may effect prolonged changes of the immune system and clinical remission in patients with SLE.

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