Using stem cells as a "rescue mechanism" following heavy drug treatment was discussed by Professor ALAN TYNDALL (Felix-Platter Spital, Basel, Switzerland).
Autoimmune diseases, including RA, could be treated with immunosuppressants, but the dose which could be given was limited because of the drug's toxicity to bone marrow, he said. By removing bone marrow stem cells (which generated all the different types of blood cells) before treatment, and then re-transplanting them after treatment, larger doses of immunosuppressants could be used. In about two weeks, the transplanted stem cells returned to the bone marrow and began to replenish the cells lost through drug treatment, Professor Tyndall said. "It does not matter if the bone marrow is damaged by the drugs because you can give back the stem cells immediately afterwards," he said. Professor Tyndall presented the results of a trial of 275 patients treated with the stem cell rescue technique. It was in early stages, but two-thirds of patients' disease stabilised or improved, he said. A prospective, randomised trial was now needed.
There were risks associated with the treatment. Bone marrow transplantation could be dangerous with a mortality rate of 8-9 per cent, he said. Therefore, the consequences of disease progression had to outweigh this risk. Re-transplantation was safer than getting someone else's cells, he added.
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