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Rheumatology 1999; 38: 747-750
© 1999 British Society for Rheumatology

Paediatric Rheumatology: Autologous Stem Cell Transplantation in Rheumatic Diseases of Childhood

Side-effects of long-term immunosuppression versus morbidity in autologous stem cell rescue: striking the balance

Series Editor: P. Woo

D. Niethammer, J. Kümmerle-Deschner and G. E. Dannecker

Department of Paediatrics, University of Tübingen, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany

Correspondence to: D. Niethammer, Department of Paediatrics, University of Tübingen, Hoppe-Seyler-Strasse 1, D-72076 Tübingen, Germany.

Prolonged, long-term immunosuppression is the state-of-the-art therapy for many autoimmune diseases, as more specific treatment options are still unavailable. Immunosuppressive therapy is especially problematic in children, particularly when the drug regimen contains steroids or higher doses of methotrexate (MTX) for a long period of time. Recent observations in stem cell-transplanted adult patients, indicating that signs of severe autoimmune disease disappeared for certain time periods or vanished completely [1–6], suggested that high-dose chemotherapy with autologous stem cell rescue could also be a successful treatment option for severe autoimmune disease in children. The question which remains to be answered at present is whether the possible benefit of this procedure is not outweighed by its morbidity and mortality.

The present paper does not actually compare short-term vs long-term immunosuppression, but long-term treatment in both instances which is terminated in one case by intensive short-term chemotherapy, as currently no child . . . [Full Text of this Article]

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