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J Crohns Colitis. 2017 Oct 1;11(10):1161-1168. doi: 10.1093/ecco-jcc/jjx054.

Autologous Haematopoietic Stem Cell Transplantation for Refractory Crohn's Disease: Efficacy in a Single-Centre Cohort.

Author information

1
Gastroenterology Department, Hospital Clínic de Barcelona, CIBEREHD, Institut d'investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), Barcelona, Spain.
2
Hematology Department-HSCT Unit, Hospital Clínic de Barcelona, Barcelona, Spain.
3
Hemotherapy and Hemostasis Department, Hospital Clínic de Barcelona, Barcelona, Spain.
4
EURECAT, Centre Tecnològic de Catalunya, Barcelona, Spain.

Abstract

Background:

Haematopoietic stem cell transplantation [HSCT] is considered a therapeutic option for patients with severe Crohn's disease [CD] unresponsive to currently available therapies.

Methods:

Autologous HSCT was considered for CD patients with active disease, unresponsive or intolerant to approved medications and unsuitable for surgery. After HSCT, patients were closely followed up every 6 weeks during the first 2 years and every 6 months thereafter up to 5 years. Colonoscopy and/or magnetic resonance imaging were performed at Months 6, 12, 24, and 48 after HSCT.

Results:

From December 1, 2007 to December 31, 2015, 37 CD patients were assessed for HSCT. Of these, 35 patients [13 within the ASTIC trial] underwent mobilisation. Six patients did not complete the transplant for various reasons and 29 patients were finally transplanted. Patients were followed up during a median of 12 months [6-60]. At 6 months, 70% of patients achieved drug-free clinical remission (Crohn's Disease Index of Severity [CDAI] < 150). The proportion of patients in drug-free remission (CDAI < 150, Simple Endoscopic activity Score [SES]-CD < 7] was 61% at 1 year, 52% at 2 years, 47% at 3 years, 39% at 4 years, and 15% at 5 years. Patients who relapsed were re-treated and 80% regained clinical remission. Six out of the 29 [21%] required surgery. One patient died due to systemic cytomegalovirus infection 2 months after transplant.

Conclusions:

HSCT is a salvage therapy for patients with extensive and refractory CD. Although relapse occurs in a majority of patients within 5 years after transplant, drug responsiveness is regained and clinical remission achieved in 80% of cases.

KEYWORDS:

Autologous haematopoietic stem cell transplantation; Crohn’s disease; cellular therapy

PMID:
28419282
DOI:
10.1093/ecco-jcc/jjx054
[Indexed for MEDLINE]

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