0

The full content of Annals is available to subscribers

Subscribe/Learn More  >
Brief Communications |

Immunoablative High-Dose Cyclophosphamide without Stem-Cell Rescue for Refractory, Severe Autoimmune Disease

Robert A. Brodsky, MD; Michelle Petri, MD; B. Douglas Smith, MD; Eric J. Seifter, MD; Jerry L. Spivak, MD; Michael Styler, MD; Chi V. Dang, MD, PhD; Isadore Brodsky, MD; and Richard J. Jones, MD
[+] Article and Author Information

From Johns Hopkins University School of Medicine, Baltimore, Maryland; and Hahnemann University, Philadelphia, Pennsylvania. Acknowledgments: The authors thank Chriscinthia Blount for assistance in manuscript preparation; Phillip Seaman for providing excellent clinical care; and the patient coordinator, Donna Dorr, for help with patient accrual. Grant Support: In part by National Institutes of Health grants CA15396, CA70970, and AR43727. Dr. R.A. Brodsky is an American Society of Hematology Junior Faculty Scholar. Requests for Reprints: Robert A. Brodsky, MD, Johns Hopkins Oncology Center, Room 2-127, 600 North Wolfe Street, Baltimore, MD 21287-8967. Current Author Addresses: Dr. R.A. Brodsky, Dr. Smith, Dr. Seifter, and Dr. Jones: Johns Hopkins Oncology Center, Room 2-127, 600 North Wolfe Street, Baltimore, MD 21287-8967.


Copyright ©2004 by the American College of Physicians


Ann Intern Med. 1998;129(12):1031-1035. doi:10.7326/0003-4819-129-12-199812150-00007
Text Size: A A A

Background: Immunoablative high-dose cyclophosphamide without stem-cell rescue induces durable, complete remission in most patients with aplastic anemia.

Objective: To determine the efficacy of high-dose cyclophosphamide in various refractory, severe autoimmune diseases.

Design: Prospective phase II study.

Setting: Johns Hopkins University (Baltimore, Maryland) and Hahnemann University (Philadelphia, Pennsylvania).

Patients: Eight patients with refractory, severe autoimmune disease.

Intervention: Immunoablative high-dose cyclophosphamide (50 mg/kg of body weight per day) for 4 consecutive days.

Measurements: Clinical and laboratory variables of autoimmune disease.

Results: Seven patients improved markedly: Five achieved complete remission and two achieved partial remission. Four patients have remained in continuous complete remission for 3 to 21 months, and two patients in partial remission continue to improve after 14 and 19 months of follow-up. High-dose cyclophosphamide was well tolerated; median times to a neutrophil count of 0.5 × 109 cells/L and platelet transfusion independence were 17 and 16 days, respectively.

Conclusions: Immunoablative high-dose cyclophosphamide without stem-cell rescue can induce complete remission in patients with refractory, severe autoimmune disease. Reemergence of marrow function is similar to that seen after autologous transplantation and does not carry the risk for reinfusion of autoaggressive lymphocytes with the autograft.

Figures

Tables

References

Letters

NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).

Comments

Submit a Comment
Submit a Comment

Summary for Patients

Clinical Slide Sets

Terms of Use

The In the Clinic® slide sets are owned and copyrighted by the American College of Physicians (ACP). All text, graphics, trademarks, and other intellectual property incorporated into the slide sets remain the sole and exclusive property of the ACP. The slide sets may be used only by the person who downloads or purchases them and only for the purpose of presenting them during not-for-profit educational activities. Users may incorporate the entire slide set or selected individual slides into their own teaching presentations but may not alter the content of the slides in any way or remove the ACP copyright notice. Users may make print copies for use as hand-outs for the audience the user is personally addressing but may not otherwise reproduce or distribute the slides by any means or media, including but not limited to sending them as e-mail attachments, posting them on Internet or Intranet sites, publishing them in meeting proceedings, or making them available for sale or distribution in any unauthorized form, without the express written permission of the ACP. Unauthorized use of the In the Clinic slide sets will constitute copyright infringement.

Toolkit

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Advertisement
Related Articles
Topic Collections
PubMed Articles

Buy Now

to gain full access to the content and tools.

Want to Subscribe?

Learn more about subscription options

Forgot your password?
Enter your username and email address. We'll send you a reminder to the email address on record.
(Required)
(Required)