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Autologous blood stem cell transplantation in refractory systemic lupus erythematodes with recurrent longitudinal myelitis and cerebral infarction

Department of Neurology at the University of Cologne, Germany

C Scheid

Medical Clinic I at the University of Cologne, Germany

U Holtik

Medical Clinic I at the University of Cologne, Germany

L Burghaus

Department of Neurology at the University of Cologne, Germany

M Neveling

Department of Neurology at the University of Cologne, Germany

P Impekoven

Department of Neuroradiology at the University of Cologne, Germany

A Rüger

Department of Neurology at the University of Cologne, Germany

M Hallek

Medical Clinic I at the University of Cologne, Germany

A H Jacobs

Department of Neurology at the University of Cologne, Germany

A Rubbert

Medical Clinic I at the University of Cologne, Germany, Andrea.Rubbert{at}medizin.uni-koeln.de

Autologous hematopoietic stem cell transplantation (ASCT) has the potential to eliminate autoreactive lymphocytes and may represent a therapeutic option for patients with refractory autoimmune diseases. We describe a 19-year old woman with neuropsychiatric systemic lupus erythematodes (NPSLE) presenting with acute longitudinal myelitis and aseptic meningitis. Despite therapy with methylprednisolone and cyclophosphamide (CYC), recurrence of longitudinal myelitis and a disabling stroke-like relapse occurred. Hematopoietic stem cells were mobilized by CYC at 2 g/m² and G-CSF. The patient was conditioned by CYC at 200 mg/kg and anti-thymocyte globulin and 3.6 = 10⁶ CD34+ cells/kg were infused. Hematopoietic regeneration was observed on day 12 after ASCT. Currently, 18 months after ASCT, the patient is in clinical remission with no evidence for residual serological or neuroradiological activity of SLE. Although a longer follow-up will be needed to reliably assess the efficacy of ASCT in this patient, the present case demonstrates that ASCT may represent a therapeutic option for patients with severe NPSLE.

Key Words: acute longitudinal myelitis • antiphospholipid syndrome • aseptic meningitis • autologous hematopoietic stem cell transplantation • neuropsychiatric systemic lupus erythematodes

Lupus, Vol. 15, No. 4, 240-243 (2006)
DOI: 10.1191/0961203306lu2269cr


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