Crohn’s disease complicated by relapsed extranodal Hodgkin’s lymphoma: prolonged complete remission after unmanipulated PBPC autotransplant

Musso, Maurizio; Porretto, Ferdinando; Crescimanno, Alessandra; Bondì, Francesca; Polizzi, Vita; Scalone, Renato

doi:10.1038/sj.bmt.1702621

Cited by 41 publications

(19 citation statements)

References 14 publications

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“…8 This is supported by promising reports on single BD patients treated by stem cell transplantation -allogeneic or autologous -due to leukemia or malignant lymphomas. [9][10][11][12] Recently, two patients with CD have been described in whom, in a period of high clinical activity, (CDAI 308 and 267, respectively) aPBSCT+antithymocyte globulin (ATG) resulted in an impressive response lasting more than 1 year. 13 However, there remained a mild to moderate endoscopical and/or histological inflammation.…”

Section: Discussionmentioning

confidence: 99%

Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation

Kreisel

Potthoff

Bertz

et al. 2003

Bone Marrow Transplant

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Summary:In a 36-year-old male with ileocolic Crohn's disease (CD) no long-lasting remission was obtained by treatment with corticosteroids, mesalazine, azathioprine and antibiotics. Surgical interventions due to relapsing fistulae and abscesses resulted in the removal of 41.5 m of small bowel and left only 40 cm of large bowel. In July 2000, a new fistula and abscess developed. The combination of corticosteroids, mesalazine, ciprofloxacin, metronidazol, azathioprine, formula diet and anti-TNF-a antibody largely reduced clinical activity, and resection of fistula and abscess were successful. Despite clinical remission, histology showed activity in the small bowel and the colon. In March 2001, stem cell mobilization chemotherapy with cyclophosphamide was performed. It induced an endoscopic remission for 9 months, which was maintained on azathioprine and corticosteroids. After relapse, in March 2002, high-dose chemotherapy with cyclophosphamide and reinfusion of T-cell-depleted autologous peripheral CD34+ blood stem cells were performed. This led to a complete clinical, endoscopical and histological remission for 9 months without any treatment. Thereafter, endoscopy showed initial aphthous lesions with minimal histological signs of inflammation. The patient is asymptomatic, but low-dose prednisolone and methotrexate are prophylactically given. Immunoablative chemotherapy followed by autologous peripheral blood stem cell transplantation may be a beneficial therapeutic option in complicated refractory CD.

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Section: Discussionmentioning

confidence: 99%

Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation

Kreisel

Potthoff

Bertz

et al. 2003

Bone Marrow Transplant

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“…To date, 26 IBD cases consisting of 21 CD and five UC patients who underwent HSCT (eight autologous and 18 allogeneic) for cancer have been reported [8,[10][11][12][13][14][15][16][17][18]. Overall, 24 of 27 (88.9 %) patients have achieved clinical remission in the follow-up periods of 0.5 to 8 years.…”

Section: Hsct and Ibdmentioning

confidence: 99%

Stem cell therapy for inflammatory bowel disease

2015

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Inflammatory bowel disease (IBD) could be curable by ''immune rest'' and correction of the genetic predisposition inherent in allogeneic hematopoietic stem cell transplantation. However, balancing risks against benefits remains challenging. The application of mesenchymal stem cells (MSCs) serving as a site-regulated ''drugstore'' is a recent concept, which suggests the possibility of an alternative treatment for many intractable diseases such as IBD. Depending on the required function of MSC, such as a cell provider, immune moderator, and/or trophic resource, MSC therapy should be optimized to maximize its therapeutic benefit. Therapeutic effects do not always require full engraftment of MSCs. Therefore, optimization of pleiotropic gut trophic factors produced by MSCs, which favoring not only regulating immune responses but also promoting tissue repair, must directly enhance new drug discoveries for treatment of IBD. Stem cell biology holds great promise for a new era of cell-based therapy, sparking considerable interest among scientists, clinicians, and patients. However, the translational arm of stem cell science remains in a relatively primitive state.Although several clinical studies using MSCs have been initiated, early results suggest several inherent problems. In each study, optimization of MSC therapy appears to be the most urgent problem, and can be resolved only by scientifically unveiling the mechanisms of therapeutic action. In the present review, the authors outline how such information would facilitate the critical steps in the paradigm shift from basic research on stem cell biology to clinical practice of regenerative medicine for conquering IBD in the near future.

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“…42 Four patients suffering from active Crohn's disease 8.5 years (median, range: 4-10) entered unsupported remission states of Crohn's disease for 1.5 years (median, range: 0.8 to 10 years) after transplant. [44][45][46][47] Two of them died from malignancy, while the Crohn's disease remained in remission for 10 and 25 months. 45,46 Four patients suffering from psoriasis for 13, 15 and 20 years were given autologous transplants for comorbid hematologic malignancies.…”

Section: Outcome Of Hematologic Malignancies and Responses Of Concomimentioning

confidence: 99%

“…34,42,45,46 Five patients enjoy unmaintained remission of their AID for a median duration of 36 months (range: 19 to 120). 41,44,47,49 A patient with large cell lymphoma and hemophilia A with a natural inhibitor of factor VIII experienced a reduction of factor VIII inhibitor from 752 to 1 BU/ml. 39 Two of four patients with SLE relapsed after 12 and 36 months post transplant.…”

Section: Outcome Of Hematologic Malignancies and Responses Of Concomimentioning

confidence: 99%

Clinically demonstrable anti-autoimmunity mediated by allogeneic immune cells favorably affects outcome after stem cell transplantation in human autoimmune diseases

Hinterberger

Hinterberger-Fischer

Marmont

2002

Bone Marrow Transplant

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Summary:To determine the role of allogeneic, autologous and syngeneic hemopoietic stem cell transplantation (SCTx) as a treatment for severe autoimmune disease (AID) we performed a literature search employing Medline, Cancer Lit and abstract books for reports on transplants for blood disorders and a concomitant AID. All reviews, case reports and abstracts available between June 1977 and September 2001 were used and attempts made to update them by e-mail by the corresponding authors. Disease-free survival (DFS) after allogeneic SCTx for 23 patients with severe aplastic anemia was 78% at 16 years and survival in unmaintained remission of concomitant AID was 64% at 13 years. DFS after allogeneic SCTx for 24 patients with hematologic malignancies was 87% at 15 years and survival in unmaintained remission for concomitant AID was 70% at 11 years. DFS after autologous SCTx for 24 patients with hematologic malignancies was 48% at 6 years and survival in unmaintained remission for concomitant AID was 29% at 3 years. Among 30 patients given allogeneic SCTx 19 developed graft-versus-host disease (GVHD) and 11 did not. Upon clinically justified discontinuation of all immunosuppressive therapy, 3/11 patients without GVHD relapsed with their concomitant AID (freedom of AID-relapse 69% at 9 years), whereas none of 19 patients with GVHD did so (log rank: P ‫؍‬ 0.0135). Freedom of AID-relapse was superior after allo SCTx compared to autologous SCTx (89% at 18 years vs 38% at 5 years; log rank: P ‫؍‬ 0.0002). Our data suggest that a graft-versus-autoimmunity effect after allogeneic hemopoietic SCTx mediates elimination of autoimmunity.

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Crohn’s disease complicated by relapsed extranodal Hodgkin’s lymphoma: prolonged complete remission after unmanipulated PBPC autotransplant

Cited by 41 publications

References 14 publications

Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation

Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation

Stem cell therapy for inflammatory bowel disease

Clinically demonstrable anti-autoimmunity mediated by allogeneic immune cells favorably affects outcome after stem cell transplantation in human autoimmune diseases

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