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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, Author, and Disclosure 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
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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.





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