Immunoablative high-dose cyclophosphamide without stem-cell rescue for refractory, severe autoimmune disease.

BACKGROUND

Immunoablative high-dose cyclophosphamide without stem-cell rescue induces durable, complete remission in most patients with aplastic anemia.

OBJECTIVE

To determine the efficacy of high-dose cyclophosphamide in various refractory, severe autoimmune diseases.

DESIGN

Prospective phase II study.

SETTING

Johns Hopkins University (Baltimore, Maryland) and Hahnemann University (Philadelphia, Pennsylvania).

PATIENTS

Eight patients with refractory, severe autoimmune disease.

INTERVENTION

Immunoablative high-dose cyclophosphamide (50 mg/kg of body weight per day) for 4 consecutive days.

MEASUREMENTS

Clinical and laboratory variables of autoimmune disease.

RESULTS

Seven patients improved markedly: Five achieved complete remission and two achieved partial remission. Four patients have remained in continuous complete remission for 3 to 21 months, and two patients in partial remission continue to improve after 14 and 19 months of follow-up. High-dose cyclophosphamide was well tolerated; median times to a neutrophil count of 0.5 x 10(9) cells/L and platelet transfusion independence were 17 and 16 days, respectively.

CONCLUSIONS

Immunoablative high-dose cyclophosphamide without stem-cell rescue can induce complete remission in patients with refractory, severe autoimmune disease. Reemergence of marrow function is similar to that seen after autologous transplantation and does not carry the risk for reinfusion of autoaggressive lymphocytes with the autograft.