Stem Cell Transplantation

The progress in bone marrow and stem cell transplantation for malignant hematologic disorders has provided protocols that may be transferred to benign yet chronic or life-threatening immunologic disorders (Cohen andNagler 2002, Moore et al. 2001, Traynor et al. 2002, Tyndall et al. 2000). Approximately 500 patients with severe autoimmune diseases have undergone autologous hematopoietic stem cell transplantation in the past 5 years (Cohen and Nagler 2002, Furst 2002, Gratwohl et al. 2001, Moore et al. 2001, Openshaw et al. 2002, Traynor et al. 2002, Tyndall and Koike 2002, Tyndall et al. 2000). Data have been compiled by Tyndall and Koike (Tyndall and Koike 2002), including patients with severe, organ-threatening SLE. For isolated CLE, this therapy certainly does not represent a feasible option. Even for SLE, this approach is controversially discussed, as data suggest no major improvement compared with high-dose cyclophosphamide immunoablative therapy without stem cell rescue (Traynor et al. 2002, Tyndall and Koike 2002). Therefore, this concept of

"immunologic resetting" needs further evaluation with longer follow-up and multicenter randomized studies.

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