Hematopoietic stem cell transplantation for systemic sclerosis: Brazilian experience

Author(s):Show less -

Henrique-Neto, Alvaro ^[1] ; Vasconcelos, Marianna Yumi Kawashima ^{[1, 2]} ; Dias, Juliana Bernardes Elias ^[3] ; de Moraes, Daniela Aparecida ^[3] ; Goncalves, Maynara Santana ^{[2, 4]} ; Zanin-Silva, Djulio Cesar ^{[5, 2]} ; Zucoloto, Talita Graminha ^{[1, 2, 3]} ; de Oliveira, Marilia de Fatima Cirioli ^{[3, 6]} ; Dotoli, Giuliana Martinelli ^{[1, 2]} ; Weffort, Luiz Fernando ^[3] ; Leopoldo, Vanessa Cristina ^{[3, 6]} ; Oliveira, Maria Carolina ^{[2, 7]}

Affiliation

^[1] Univ Sao Paulo, Ribeirao Preto Med Sch, Grad Program Internal Med, Ribeirao Preto - Brazil

^[2] Univ Sao Paulo, Ribeirao Preto Med Sch, Ctr Cell Based Therapy, Ribeirao Preto - Brazil

^[3] Univ Sao Paulo, Ribeirao Preto Med Sch, Hosp Clin, Fac Med Ribeirao Preto, Ribeirao Preto - Brazil

^[4] Univ Sao Paulo, Ribeirao Preto Med Sch, Grad Program Oncol Stem Cells & Cell Therapy, Ribeirao Preto - Brazil

^[5] Univ Sao Paulo, Ribeirao Preto Med Sch, Grad Program Basic & Appl Immunol, Ribeirao Preto - Brazil

^[6] Univ Sao Paulo, Ribeirao Preto Sch Nursing, Ribeirao Preto - Brazil

^[7] Univ Sao Paulo, Ribeirao Preto Med Sch, Dept Internal Med, Ave Bandeirantes 3900, BR-14048900 Ribeirao Preto, SP - Brazil

• Document type: Journal article
• Source: ADVANCES IN RHEUMATOLOGY; v. 61, n. 1 DEC 6 2021.
• Web of Science Citations: 0

Abstract

Background In the past 20 years, hematopoietic stem cell transplantation (HSCT) has been investigated as treatment for systemic sclerosis (SSc). The goal of HSCT is to eradicate the autoreactive immune system, which is replaced by a new immune repertoire with long-lasting regulation and tolerance to autoantigens. Here, we describe the clinical outcomes of severe and refractory SSc patients that underwent HSCT at a single Brazilian center. Patients and methods This is a longitudinal and retrospective study, including 70 adult SSc patients, with an established diagnosis of SSc, and who underwent autologous HSCT from 2009 to 2016. The procedure included harvesting and cryopreservation of autologous hematopoietic progenitor cells, followed by administration of an immunoablative regimen and subsequent infusion of the previously collected cells. Patients were evaluated immediately before transplantation, at 6 months and then yearly until at least 5-years of post-transplantation follow-up. At each evaluation time point, patients underwent clinical examination, including modified Rodnan's skin score (mRSS) assessment, echocardiography, high-resolution computed tomography of the lungs and pulmonary function. Results Median (range) age was 35.9 (19-59), with 57 (81.4%) female and median (range) non-Raynaud's disease duration of 2 (1-7) years. Before transplantation, 96% of the patients had diffuse skin involvement, 84.2%, interstitial lung disease and 67%, positive anti-topoisomerase I antibodies. Skin involvement significantly improved, with a decline in mRSS at all post-transplantation time points until at least 5-years of follow-up. When patients with pre-HSCT interstitial lung disease were analyzed, there was an improvement in pulmonary function (forced vital capacity and diffusing capacity of lung for carbon monoxide) over the 5-year follow-up. Overall survival was 81% and progression-free survival was 70.5% at 8-years after HSCT. Three patients died due to transplant-related toxicity, 9 patients died over follow-up due to disease reactivation and one patient died due to thrombotic thrombocytopenic purpura. Conclusions Autologous hematopoietic progenitor cell transplantation improves skin and interstitial lung involvement. These results are in line with the international experience and support HSCT as a viable therapeutic alternative for patients with severe and progressive systemic sclerosis. (AU)

• FAPESP's process: 13/08135-2 - CTC - Center for Cell-Based Therapy
• Grantee: Dimas Tadeu Covas
• Support Opportunities: Research Grants - Research, Innovation and Dissemination Centers - RIDC