TY - JOUR
T1 - Hematopoietic stem cell transplantation (HSCT)
T2 - An approach to autoimmunity
AU - Alaez, Carmen
AU - Loyola, Mariana
AU - Murguía, Andrea
AU - Flores, Hilario
AU - Rodríguez, Araceli
AU - Ovilla, Roberto
AU - Ignacio, Gregorio
AU - Amador, Raquel
AU - Salinas, Victor
AU - Perez, Fernanda
AU - Rodríguez, Danaee
AU - Morales, Zoila
AU - Llinguin, Gonzalo
AU - Vazquez, Alejandra
AU - Altamirano, Analia
AU - Gorodezky, Clara
N1 - Funding Information:
This study was done greatly with the support of The Fundación Comparte Vida, A.C. Foundation that supports DONORMO & BACECU in Mexico. Take-Home Messages • The Major Histocompatibility Complex plays a central role in allogeneic HSCT • Minor Histocompatibility Antigens, NK cells and KIR genes are important for HSCT outcome • Engraftment, rejection, GVHD, GVL, infections and drug toxicity are relevant influences in transplantation • Animal models have been the key to understand the biological and molecular mechanisms occurring in transplantation of autoimmune diseases • Autologous bone marrow transplantation has been beneficial for patients with MS, RA, Ssc and perhaps soon in SLE and juvenile idiopathic arthritis. Allogeneic HSCT is being applied in some disorders. Unrelated HSCT is an important tool for patients who do not have an identical HLA match within the family • Efficacy of HSCT will be achieved comparing this procedure with standard therapy for AD.
PY - 2006/3
Y1 - 2006/3
N2 - HSCT provides the opportunity to replace a damaged tissue. It is the most important treatment for high risk hematologic malignant and non malignant disorders. An important challenge in the identification of matched donors/patients is the HLA diversity. The Mexican Bone Marrow Registry (DONORMO) has nowadays > 5000 donors. The prevalent alleles are Amerindian, Mediterranean (Semitic and Spanish genes) and African. In theory, it is possible to find 11% of 6/6 A-B-DR low resolution matches for 70% of patients with Mexican ancestry. We contributed with 39 unrelated, cord blood and autologous HSCT for patients with malignant, genetic and autoimmune disorders. Overall disease survival was 50% (2-7 years) depending on the initial diagnosis, conditioning, disease evolution or other factors. Clinical studies using autologous and unrelated HSC are performed on patients with refractory autoimmune diseases producing mixed results: mainly, T1D, RA, MS, SLE. Improvement has been observed in skin damage and quality of life in SLE and systemic sclerosis. Disease stabilization in 2/3 of MS patients. However, in RA and T1D, initial benefits have been followed by eventual relapse. With growing clinical experience and protocol improvement, treatment-related mortality is decreasing. Proof efficacy will be achieved by comparing HSCT with standard therapy in autoimmunity.
AB - HSCT provides the opportunity to replace a damaged tissue. It is the most important treatment for high risk hematologic malignant and non malignant disorders. An important challenge in the identification of matched donors/patients is the HLA diversity. The Mexican Bone Marrow Registry (DONORMO) has nowadays > 5000 donors. The prevalent alleles are Amerindian, Mediterranean (Semitic and Spanish genes) and African. In theory, it is possible to find 11% of 6/6 A-B-DR low resolution matches for 70% of patients with Mexican ancestry. We contributed with 39 unrelated, cord blood and autologous HSCT for patients with malignant, genetic and autoimmune disorders. Overall disease survival was 50% (2-7 years) depending on the initial diagnosis, conditioning, disease evolution or other factors. Clinical studies using autologous and unrelated HSC are performed on patients with refractory autoimmune diseases producing mixed results: mainly, T1D, RA, MS, SLE. Improvement has been observed in skin damage and quality of life in SLE and systemic sclerosis. Disease stabilization in 2/3 of MS patients. However, in RA and T1D, initial benefits have been followed by eventual relapse. With growing clinical experience and protocol improvement, treatment-related mortality is decreasing. Proof efficacy will be achieved by comparing HSCT with standard therapy in autoimmunity.
KW - Allogeneic
KW - Autoimmune diseases (AD)
KW - Autologous
KW - HLA
KW - Hematopoietic stem cell transplantation (HSCT)
KW - MHC
KW - Unrelated HSCT
UR - http://www.scopus.com/inward/record.url?scp=32544432848&partnerID=8YFLogxK
U2 - 10.1016/j.autrev.2005.06.003
DO - 10.1016/j.autrev.2005.06.003
M3 - Artículo
C2 - 16483916
AN - SCOPUS:32544432848
SN - 1568-9972
VL - 5
SP - 167
EP - 179
JO - Autoimmunity Reviews
JF - Autoimmunity Reviews
IS - 3
ER -