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High-Dose Chemotherapy and Syngeneic Hemopoietic Stem-Cell Transplantation for Severe, Seronegative Rheumatoid Arthritis

Geoff McColl, MBBS, FRACP, PhD; Hitoshi Kohsaka, MD; Jeff Szer, MBBS, FRACP; and Ian Wicks, MBBS, FRACP, PhD
[+] Article and Author Information

From The Royal Melbourne Hospital, Victoria, Australia, and Tokyo Medical and Dental University, Tokyo, Japan.


Acknowledgment: The authors thank Professor Don Metcalf for critical review of the manuscript.

Grant Support: By grants from the National Health and Medical Research Council of Australia and the Reid Charitable Trusts.

Requests for Reprints: Ian P. Wicks, MBBS, FRACP, PhD, Reid Rheumatology Laboratory, The Walter and Eliza Hall Institute of Medical Research, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia. For reprint orders in quantities exceeding 100, please contact the Reprints Coordinator; phone, 215-351-2657; e-mail, reprints@mail.acponline.org.

Current Author Addresses: Dr. McColl: Centre for Rheumatic Diseases and Rheumatology Unit, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.

Dr. Kohsaka: First Department of Internal Medicine, School of Medicine, Tokyo Medical and Dental University, Tokyo 113-8519, Japan.

Associate Professor Szer: Bone Marrow Transplant Service, Department of Clinical Haematology & Medical Oncology, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.

Professor Wicks: Reid Rheumatology Laboratory, The Walter and Eliza Hall Institute of Medical Research, Rheumatology Unit and Centre for Rheumatic Diseases, Post Office, The Royal Melbourne Hospital, Victoria 3050, Australia.


Ann Intern Med. 1999;131(7):507-509. doi:10.7326/0003-4819-131-7-199910050-00005
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Treatment of severe autoimmune diseases, particularly rheumatoid arthritis, with high-dose chemotherapy and autologous stem-cell transplantation is the subject of considerable debate (12). This discussion has focused on likely outcomes, patient selection, the most appropriate regimen, and whether T-cell depletion of the stem-cell graft might decrease the risk for disease recurrence. We describe a patient with severe, treatment-resistant rheumatoid arthritis who received high-dose cyclophosphamide and antithymocyte globulin. Hemopoietic rescue was achieved with peripheral blood stem cells (PBSCs) from the patient's identical twin brother.

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Figures

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Figure.
Expressed T-cell receptorBVgene repertoires of twin brothers. Top.diamondssquaresBottom.

Before syngeneic peripheral blood stem-cell transplantation, the donor ( ) and the recipient ( ) twins had discordant T-cell repertoires. Sixteen weeks after transplantation, the recipient's T-cell repertoire was almost identical to that of the donor.

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Summary for Patients

A Novel but Potentially Risky Therapy for Severe Rheumatoid Arthritis

The summary below is from the full report titled “High-Dose Chemotherapy and Syngeneic Hemopoietic Stem-Cell Transplantation for Severe, Seronegative Rheumatoid Arthritis.” It is in the 5 October 1999 issue of Annals of Internal Medicine (volume 131, pages 507-509). The authors are G. McColl, H. Kohsaka, J. Szer, and I. Wicks.

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