High-dose immunosupressive therapy and stev haemopoetic cell tranplantation in refractory systemic lupus erythematosus with kidney involvement: long-term results


A.A. Demin, V.A. Kozlov, I.A. Lisukov, T.N. Sentiakova, A.D. Kulagin, E.V. Malyh, I.V. Kriuchkova, A.E. Sizikov, S.A. Sizikova, L.P. Konenkova, O.A. Gertsog, V.V. Sergeevicheva, M.N. Afonkina, O.S. Kotova

Aim. Analysis of efficacy of high dose immunosuppressive therapy combined with transplantation of autologous stem cells in systemic lupus erythematosus and lupus nephritis, refractory to standard treatment regimens. Methods. 10 patients with systemic lupus erythematosus and lupus nephritis, refractory to standard treatment regimens, were included into the study. All patients were women in age 18 - 36 years. 5 patients had lupus nephritis class IV, 5 - lupus nephritis class III. High dose immunosuppressive therapy was performed in 10 of this patients, in 9 of them - in combination with autologous stem cells transplantation. Bone marrow was used as a source of stem cells in 1 patient, in 9 they were mobilized by cyclophosphamide and colony-stimulatinmg factor. Treament efficacy was assessed during 1 and 12 months, 5-year survival was also determined. Results. Early (day 11 and 22) mortality from infectious complications was detected in 2 patients. In 1 month systemic lupus erythematosus activity decreased from III to I in degree in 6 patients, in 1 patient - from III to II, in 1 patient remission developed without stem cell transplantation. SLEDAI index, as well as serum level of anti-DNA antibodies, erythrocyte sedimentation rate, proteinuria also decreased. In 12 months disease was stable. In final analysis (median 39,6 ± 6,9 months after stem cell transplantation) incomplete remissiom was detected in 6 patients, lupus nephritis progression - in 1. 5-year survival was 78%. Renal mortality was not detected. In early period after stem cell transplantation systemic infectious complications, that lead to death, were detected in 2 patients, neutropenia - in 9, thrombocytopenia - in 5, enteropathy - in 1, mucositis - in 1, curable bacterial infection - in 1. In long term follow-up in 1 mild cytopenia was seen, in 1 - recurrent herpes infection, in 3 - hyperuricemia, in 2 - interstitial nephrititis. In 1 patient renal cell carcinoma was diagnosed and successful kidney resection was performed. Conclusion. High dose immunosuppressive therapy combined with transplantation of autologous stem cells can be effective in more than 50% of patients with systemic autologous stem cells lupus erythematosus and lupus nephritis, refractory to standard treatment regimens.

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