Abstract:

ABSTRACT Objective: To evaluate the efficiency and safety of the treatment of autologous hematopoietic stem cell transplantation (ASCT) for patients with severe lupus nephritis (LN). Methodology: From Jul 2011 through Jan 2014, a total of twenty patients with severe LN refractory to standard immunosuppressive therapies were enrolled in this study. Peripheral blood stem cells were mobilized with cyclophosphamide (CTX) and granulocyte colony-stimulating factor (G-CSF), and reinfused after treatment with CTX and antithymocyte globulin. The primary end point was remission rate, and secondary end points included the survival and relapse rate, changes in proteinuria, renal function and serology immunologic test. All the complications were recorded for safety access. Results: They were 8 males and 12 females with a median LN duration of 45.5 months. The IV+V type was the dominant renal pathologic type. The mean SLE Disease Activity Index (SLE-DAI) was 14.7±4.28 points. The mean number of CD34+ cells was (7.5±4.12) ×106/kg. All patients had successful engraftment, and the median time of granulocyte and platelet engraftment was both 8 days. The major complications of ASCT were fever and symptom of gastrointestinal tract. Treatment-related mortality was 5% (1/20). With a mean follow-up of 21 months (range, 6 months to 36 months), fourteen patients achieved completed remission, 3 partial remission, one had no response; and only one died for sepsis. The median time of renal response was 5 months. The overall 3-year survival was 90%. 2 patients had relapse during the follow-up and the relapse rate was 11.1%. Conclusion: In treatment of severe LN, ASCT could result in amelioration of disease activity, improvement in serologic markers, and stabilization of organ dysfunction.

Key words: Lupus nephritis, Autologous hematopoietic stem cell transplantation, efficacy, complication