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Lowenthal, RM; Graham, Stewart R.

doi:10.1023/a:1006634309251

Cited by 6 publications

(1 citation statement)

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“…Despite the usage of both conventional DMARDs and newer biologicals, 40% of patients with RA continue to have frequent relapses with active and progressive disease[ 20 , 37 ]. Autologous HSCT has been considered as an alternative modality of management of such resistant candidates[ 38 ]. Although HSCs are multipotent stem cells with the potential to give rise to blood, endothelial cells, and immune cells, in the context of their role in autoimmune diseases they are viewed as immune stem cells[ 39 ].…”

Section: Discussionmentioning

confidence: 99%

Remission is not maintained over 2 years with hematopoietic stem cell transplantation for rheumatoid arthritis: A systematic review with meta-analysis

Muthu¹,

Jeyaraman²,

Ranjan³

et al. 2021

WJBC

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BACKGROUND Hematopoietic stem cell (HSC) transplantation (HSCT) is being accepted as a standard of care in various inflammatory diseases. The treatment of rheumatoid arthritis (RA) has been closely evolving with the understanding of disease pathogenesis. With the rising resistance to the traditional disease-modifying anti-rheumatic drugs and targeted biological therapy, researchers are in pursuit of other methods for disease management. Since the ultimate goal of the ideal treatment of RA is to restore immune tolerance, HSCT attracts much attention considering its reparative, paracrine, and anti-inflammatory effects. However, a systematic review of studies on HSCT in RA is lacking. AIM To investigate the role of HSCT in the management of RA. METHODS A detailed search of PubMed, Scopus, EMBASE, Cochrane, and the Web of Science databases was made to identify the relevant articles till September 2020 following Cochrane and PRISMA guidelines. We extracted data including the number of patients, source of hematopoietic stem cells, their mobilization and conditioning regimens, results, and complications from the eligible studies. Results were dichotomized into success (ACR 50/70) and failure (ACR 20) based on the improvement from baseline characteristics. The methodological quality of the included studies was also assessed. Analysis was performed using OpenMeta[Analysis] software. RESULTS We included 17 studies (1 randomized controlled trial, 11 prospective, and 5 retrospective studies) with 233 patients for analysis. HSCT provided a significantly beneficial overall improvement in the clinical grades of ACR criteria ( Z = 11.309, P < 0.001). However, the remission was noted only till 24 mo and later on the significance of the result was lost ( Z = 1.737, P = 0.082). A less than 1% treatment-related mortality was noted from the included studies. No major drug-related toxicities were noted in any of the included studies. All patients who underwent allogeneic HSCT received immunosuppression in the conditioning regimen to counteract the graft- vs -host reaction which made them vulnerable to infections. It is noted that the source of hematopoietic stem cells did not play a role in altering the functional outcome and both autologous ( Z = 9.972, P < 0.001) and allogenic ( Z = 6.978, P < 0.001) sources produced significant improvement in the outcome compared to the pre-operative state despite having a significant heterogeneity among the studies reporting them ( I 2 = 99.4, P < 0.001). CONCLUSION Although the available literature is encouraging towards the use of HSCT in refractory cases wit...

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