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High-dose immunosuppressive therapy for severe systemic sclerosis: initial outcomes

2002; Elsevier BV; Volume: 100; Issue: 5 Linguagem: Inglês

10.1182/blood.v100.5.1602.h81702001602_1602_1610

1528-0020

Peter A. McSweeney, Richard A. Nash, Keith M. Sullivan, Jan Storek, Leslie J. Crofford, Roger Dansey, Maureen D. Mayes, Kevin T. McDonagh, J. Lee Nelson, Theodore A. Gooley, Leona Holmberg, Chen‐Li Cheng, Mark H. Wener, Katherine A. Ryan, Julie Sunderhaus, Ken Russell, John A. Rambharose, Rainer Storb, Daniel E. Furst,

Dermatologic Treatments and Research

Systemic sclerosis (SSc) is a multisystem disease of presumed autoimmune pathogenesis for which no proven effective treatment exists. High-dose immunosuppressive therapy (HDIT) has been proposed as an investigational treatment for severe autoimmune diseases. Nineteen patients with poor-prognosis SSc underwent HDIT. The median age was 40 years (range, 23-61 years), the median modified Rodnan skin score (a measure of dermal sclerosis) was 31, and the median DLCO was 57%. Conditioning therapy involved 800 cGy total body irradiation (TBI) (± lung shielding to approximately 200 cGy), 120 mg/kg cyclophosphamide, and 90 mg/kg equine antithymocyte globulin. CD34-selected granulocyte–colony-stimulating factor–mobilized autologous blood stem cells provided hematopoietic rescue. With median follow-up at 14.7 months, the Kaplan-Meier estimated 2-year survival rate was 79%. Three patients died of treatment complications and one of disease progression. Two of the first 8 patients had fatal regimen-related pulmonary injury, a complication not found among 11 subsequent patients who received lung shielding for TBI. Overall, internal organ functions were stable to slightly worse after HDIT, and 4 patients had progressive or nonresponsive disease. As measured by modified Rodnan skin scores and modified health assessment questionnaire disability index (mHAQ-DI) scores, significant disease responses occurred in 12 of 12 patients evaluated at 1 year after HDIT. In conclusion, though important treatment-related toxicities occurred after HDIT for SSc, modifications of initial approaches appear to reduce treatment risks. Responses in skin and mHAQ-DI scores exceed those reported with other therapies, suggesting that HDIT is a promising new therapy for SSc that should be evaluated in prospective randomized studies.