Stem cell transplantation for Crohn’s – pro

Crohn’s disease (CD) is an inflammatory bowel disorder that involves loss of immune tolerance in the gastrointestinal tract and T helper 1 delayed-type hypersensitivity of the gut wall, frequently resulting in granuloma formation. The molecular defect causing CD has not been characterized, but probably involves aberrant T cell function. Although CD often responds to immunosuppressive medication including corticosteroids, azathioprine and 6-mercaptopurine, to anti inflammatory drugs such as 5 aminosalicylate (5 ASA), or to some antimicrobial agents, including metronidazole, no therapy has been curative.  Hematopoietic stem cell transplantation (HSCT) is being evaluated as an option for patients with refractory CD. There are several phase II studies and the randomized trial of autologous non-myeloablative therapy vs. standard treatment. There have been several reported cases in which HSCT was used to treat patients with refractory CD and cases involving patients with CD who underwent stem cell transplantation for other reasons. These studies showed varying remission of CD, both clinically and histologically.Hawkey CJ. Stem cell transplantation for Crohn’s disease. Best Pract Res Clin Haematol. 2004;17(2):317-325.
Oyama Y, Craig RM, Traynor AE, et al. Autologous hematopoietic stem cell transplantation in patients with refractory Crohn’s disease. Gastroenterology. 2005;128(3):552-563.
Lopez-Cubero SO, Sullivan KM, McDonald GB. Course of Crohn’s disease after allogeneic marrow transplantation. Gastroenterology. 1998;114(3):433-440.
Ditschkowski M, Einsele H, Schwerdtfeger R, et al. Improvement of inflammatory bowel disease after allogeneic stem-cell transplantation. Transplantation. 2003;75(10):1745-1747.
Hinterberger W, Hinterberger-Fischer M, Marmont A. Clinically demonstrable anti-autoimmunity mediated by allogeneic immune cells favorably affects outcome after stem cell transplantation in human autoimmune diseases. Bone Marrow Transplant. 2002;30(11): 753-759.
Kashyap A, Forman SJ. Autologous bone marrow transplantation for non-Hodgkin’s lymphoma resulting in long-term remission of coincidental Crohn’s disease. Br J Haematol. 1998;103(3):651-652.
Scime R, Cavallaro AM, Tringali S, et al. Complete clinical remission after high-dose immune suppression and autologous hematopoietic stem cell transplantation in severe Crohn’s disease refractory to immunosuppressive and immunomodulator therapy. Inflamm Bowel Dis. 2004;10(6):892-894.

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