The graft is free of autoreactive cells, but the risk of complications, e.g., GVHD, is significantly increased. The main advantages of this type of HSCT are that it provides a graft free of autoreactive cells and the minimal risk of graft-versus-host disease (GVHD).Īllogeneic transplantation: The progenitor cells are collected from a donor who is not genetically identical. Syngeneic transplantation: The couple-donor is an identical twin. Then, they are processed, stored, and subsequently transfused into the patient after the conditioning regimen. Based on the origin of the transplanted cells, HSCT may be:Īutologous transplantation: The progenitor cells are collected from the patient’s own tissues. The subtype of HSTC influences the short and long-term results of the procedure. Hematopoietic stem cell transplantation can be divided into subtypes based on the relationship between the patient and the donor and by the source of the stem cells. At present, it is estimated that around 3,000 AD patients have been treated by HSTC ( 7). In their consensus, it was established that methods had to follow a standardized protocol, and all the patients should be reported to the EBMT–EULAR Autoimmune Disease Data Registry ( 12). In 1996, the European League Against Rheumatism (EULAR) and the European Group for Blood and Marrow Transplantation (EBMT) supported the utilization of HSCT in patients with ADs as an experimental procedure. The first hematopoietic stem cell transplants performed specifically for ADs were done in the 90’s. The possibility of HSCT as a treatment for ADs was reinforced by reports of patients with coincident ADs and hematological malignancy who remained in long-term remission after allogeneic transplantation ( 11). The use of HSCT for ADs evolved in animal models, where experimental investigations showed that inherited and induced autoimmune disease (AD) in laboratory animals could be cured by stem cell transplantation ( 9, 10). Hematopoietic stem cell transplantation has been the standard therapy for several oncological and hematological disorders since the early 70’s ( 8). In this context, hematopoietic stem cell transplantation (HSCT) has emerged as an alternative therapy for severe and refractory ADs. There is a group of patients with refractory and life-threatening states for whom the results of conventional therapy have been considered unsatisfactory. The majority of patients achieve short-term disease control with immunosuppressive therapy including biological therapies, but long-term remission or a definitive cure remains unattainable ( 7). However, a trigger like an environmental exposure is needed to initiate frank autoreactivity in a genetically predisposed individual ( 2, 6). Epidemiologic studies have shown that genetic factors are major determinants of susceptibility to ADs ( 4, 5). The knowledge of the etiology of ADs remains limited. In some conditions, 85% or more of the patients are female ( 3). ADs disproportionally occur more in women. The concept of “autoimmune disease” includes a wide spectrum of pathologies that vary in biological and clinical features.Īutoimmune diseases (ADs) are among the most prevalent diseases in the United States, affecting approximately 7% of the population ( 2). Autoimmune disease is defined as a clinical syndrome caused by the activation of T cells and/or B cells in the absence of an ongoing infection or other discernible cause ( 1). Autoimmunity is an inappropriate response of the immune system directed against self-tissues.
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