Positive results from a risky, experimental procedure to treat a severe case of rheumatoid arthritis are provoking even more interest in stem-cell transplantation.
A report in the October 5th issue of the Annals of Internal Medicine described the first time high doses of chemotherapy followed by stem cell transplantation was used to treat a severe case of rheumatoid arthritis. The experimental procedure was led by Dr. Ian Wicks of Royal Melbourne Hospital in Victoria, Australia.
Rheumatoid arthritis (RA) is an autoimmune disease. Inflammation, pain, and debilitating joint erosion are characteristic of this disease in which a person's immune system attacks their own joints. The subject of the aforementioned experimental procedure was a 39 year old man who had suffered severe joint damage of the wrist, ankle, and shoulder joints. The man previously had a total hip replacement and had failed all standard RA therapy.
The research team used high doses of two chemotherapy drugs, cyclophosphamide and anti-thymocyte globulin, to eliminate the patients immune cells. Using a technique known as leukapheresis, stem cells were taken from the identical twin brother who does not have RA and transplanted to the patient with RA. Sixteen weeks after the stem-cell transplant, the T cell repertoire of the RA patient was nearly identical to that of his healthy brother. Even more amazingly, two years after the chemotherapy/stem-cell transplant therapy the patient is able to swim, bike, and has no joint pain or other arthritic symptoms. Notably, he did not receive any other treatment for arthritis during the two year post-transplant period.
Though the results are dramatic, researchers have expressed caution. The reported results were only based on a single case and specifically apply to patients with treatment-resistant autoimmune disease having an identical twin who is without the disease. Side effects of chemotherapy and the risks of transplantation must not be overlooked. However, the success of this experimental therapy will surely generate further research in the area of stem-cell transplantation as a possible treatment for the most severe cases of RA.
REFERENCE:
Annals of Internal Medicine, October 5, 1999
