Auto-SCT in refractory celiac disease type II patients unresponsive to cladribine therapy

G. J. Tack, M. J. Wondergem, A. Al-Toma, W. H M Verbeek, A. Schmittel, M. V. MacHado, F. Perri, G. J. Ossenkoppele, P. C. Huijgens, M. W J Schreurs, C. J J Mulder, O. J. Visser

Research output: Contribution to journalArticlepeer-review

Abstract

Autologous hematopoietic SCT (auto-SCT) has been effective therapy for refractory disease, in both malignancies and severe autoimmune diseases. It seems feasible and safe for refractory celiac disease (RCD) type II, although long-term results have not been evaluated yet. With current therapies, progression into enteropathy-associated T-cell lymphoma (EATL) occurs in 60-80% patients, with a high mortality rate. Therefore, it is important to evaluate new treatment strategies. Between March 2004 and February 2010, 18 RCD II patients were evaluated for auto-SCT preceded by conditioning with fludarabine and melphalan, as a consequence of unresponsiveness to cladribine therapy. Adverse events, survival rate, EATL development and change in clinical, histological and immunological course were monitored. Thirteen patients were transplanted successfully and followed up for >2 years, 4-year survival rate was 66%. Only one patient died because of transplant-related complications. The majority of patients showed an impressive clinical improvement and five a complete histological remission. In five patients, auto-SCT could not be performed; they all died with a median survival of 5.5 months. EATL was observed in one transplanted patient, only after 4 years of follow-up. Auto-SCT after conditioning with high-dose chemotherapy in RCD II patients unresponsive to cladribine therapy is feasible and seems promising.

Original languageEnglish
Pages (from-to)840-846
Number of pages7
JournalBone Marrow Transplantation
Volume46
Issue number6
DOIs
Publication statusPublished - Jun 2011

Keywords

  • auto-SCT
  • clinical course
  • enteropathy-associated T-cell lymphoma
  • refractory celiac disease
  • survival

ASJC Scopus subject areas

  • Hematology
  • Transplantation

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