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J Crohns Colitis. 2018 Mar 28;12(4):476-488. doi: 10.1093/ecco-jcc/jjx184.

Autologous Haematopoietic Stem Cell Transplantation (AHSCT) in Severe Crohn's Disease: A Review on Behalf of ECCO and EBMT.

Author information

1
Department of Haematology, Sheffield Teaching Hospitals NHS Foundation Trust, Royal Hallamshire Hospital, Sheffield, UK.
2
Department of Gastroenterology, Hospital Clínic, IDIBAPS, CIBERehd, Barcelona, Spain.
3
Department of Rheumatology and Clinical Immunology, Charité - University Medicine, Berlin, Germany.
4
Department of Gastroenterology, Hôpital Saint Louis, APHP, INSERM U1160, Paris Diderot, Sorbonne Paris-Cité University, Paris, France.
5
DIBIC - ASST Fatebenefratelli Sacco - University of Milan, Italy.
6
Department of Haematology, University Hospitals, Leuven, Belgium.
7
Department of Medicine II, Medical Center - University of Freiburg, Faculty of Medicine, University of Freiburg, Germany.
8
Nottingham Digestive Diseases Centre, University of Nottingham, Nottingham, UK.
9
Department of Haematology, Guys & St Thomas' NHS Foundation Trust, London, UK.
10
The Royal London Hospital, Barts Health NHS Trust, London UK & Centre for Immunobiology, Blizard Institute, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.
11
Hematology-BMT Center, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico - University of Milan, Italy.
12
Department of Haematology, Careggi University Hospital, Firenze, Italy.
13
Department of Gastroenterology - University Hospitals, Leuven, Belgium.
14
BMT Unit, Hematology Department, IDIBAPS, Hospital Clinic. Josep Carreras Leukaemia Research Institute (IJC), Barcelona, Spain.

Abstract

Despite the major recent progress in the treatment of Crohn's disease [CD], there is a subset of patients in whom the disease runs an aggressive course with progressive tissue damage requiring early and repeated surgical management. Increasing evidence supports sustained and profound improvement in gastrointestinal parameters and quality of life following high-dose immunosuppressive therapy and autologous haematopoietic stem cell transplantation [AHSCT] compared to standard therapy in this context. In addition, international transplant registry data reflect the use of AHSCT in CD outside of trials in selected patients. However, AHSCT may be associated with significant treatment-related complications with risk of transplant-related mortality. In a joint initiative, the European Crohn's and Colitis Organisation [ECCO] and the European Society for Blood and Marrow Transplantation [EBMT] have produced a state-of-the-art review of the rationale, evaluation, patient selection, stem cell mobilization and transplant procedures and long-term follow up. Given the unique spectrum of issues, we recommend that AHSCT should only be performed in experienced centres with expertise in both haematological and gastroenterological aspects of the procedure. Where possible, patients should be enrolled on clinical trials and data registered centrally. Future development should be coordinated at both national and international levels.

PMID:
29325112
DOI:
10.1093/ecco-jcc/jjx184
[Indexed for MEDLINE]

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