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Stem Cell Transplant Fights Lupus

It's a last resort for patients who aren't helped by other treatments

TUESDAY, Jan. 31, 2006 (HealthDay News) -- Doctors say they have helped people with lupus, a disease in which the immune system attacks the body's own tissue and organs, by using stem cell transplants to give them a new, less harmful, immune system.

The technique is potentially applicable to lupus patients for whom all conventional treatments have failed, said lead researcher Dr. Richard Burt, an associate professor of medicine at Northwestern University.

"No one can say this is a cure," Burt said. "But some people have been in remission for a long time." There's a chance that some have gone into permanent remission, he added.

The findings appear in the Feb. 1 issue of the Journal of the American Medical Association.

Lupus affects an estimated 1.5 million Americans, most of them young women. Symptoms range from mild fever and achy joints to severe kidney, heart, lung, liver and brain damage.

The idea was to replace the faulty immune system with one that would work properly. Starting in 1997, Burt and his colleagues at Northwestern Memorial Hospital started treating 48 patients whose lupus had not been helped by ordinary treatment.

First, the physicians extracted immune stem cells originating in the participants' own bone marrow -- immune stem cells typically begin life in the marrow. These cells were taken from the blood, however, an easier procedure than going into the marrow, explained Burt, who is also chief of the division of immunotherapy for autoimmune disease at the hospital.

The participants were also given high doses of a drug that destroyed their existing immune system cells. The isolated stem cells then were returned to the patients' bone marrow to create a new immune system. "It's like rebooting a computer," Burt said.

Results so far have been impressive, with many patients continuing in what seems to be disease-free remission. The average follow-up time in the study was 2.5 years. The researchers calculate an average survival time of five years, with patients having a 50 percent probability of remaining disease-free after five years.

Burt's research group is now working on ways to improve the transplant technique. "We've opened a new door, and there are a lot of ways to fine-tune and improve it," he said.

Meanwhile, plans are well underway for a controlled trial on a larger scale, to be done at a number of medical centers across the country.

The method might eventually be used for the 5 percent to 10 percent of lupus patients Burt said cannot be helped through traditional therapies.

But Dr. Gary Gilkeson, chairman of the medical scientific advisory committee of the Lupus Foundation of America, offered up a more cautious estimate -- 1 percent -- of how many lupus patients would be good candidates for the stem cell technique.

One reason for limiting the use of stem cell transplants is that more patients are now being helped by other treatments, Gilkeson said.

"We have better advanced therapies over what they used during the time of the study," he said.

The drastic nature of the transplant technique has to be considered, as well, Gilkeson said. "We have to review it with somewhat of a cautious eye because of the severity of the treatment," he said.

Stem cell transplant is "interesting, but it is a very invasive, high-risk procedure," Gilkeson said. "It is kind of a last resort."

More information

You can learn much about lupus from the Lupus Foundation of America.

SOURCES: Richard Burt, M.D., associate professor, medicine, Northwestern University, Chicago; Gary Gilkeson, M.D., professor, medicine, Medical University of South Carolina, Charleston; Feb. 1, 2006, Journal of the American Medical Association
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