Autologous hematopoietic stem cell transplantation to treat systemic lupus erythematosus: The first case in Vietnam

Abstract

Background: Systemic lupus erythematosus (SLE) is a chronic disease that causes systemic inflammation which affects multiple organs. There is no cure for SLE. Conventional treatment options include antimalarial drugs, corticosteroids, and immune suppressants, but a number of patients are resistant to treatment or suffer from severe side effects. Stem cell transplantation has been used to treat SLE for the past 2 decades. We describe the first Vietnamese patient with refractory SLE who received an autologous hematopoietic stem cell transplant. Case presentation: The patient is a woman who was diagnosed 12 years ago with systemic lupus erythematosus. She was administered corticosteroids and high-dose immunosuppressive medicines, but the condition was refractory, manifesting as severe headache, arthralgia, chronic anemia, severe Cushing's syndrome, and proteinuria. At admission, the SLEDAI score was 28 and proteinuria was 6.7g/l. She received cyclophosphamide and G-CSF for HSCT mobilization. Peripheral blood stem cells were collected and selected for CD34+ cells. Antithymocyte, cyclophosphamide, and rituximab were used in conditioning regimens. The patient was then administered a CD34+ autologous hematopoietic stem cell transfusion with a CD34+ dose of 7.93 x 106 cells/kg body weight, T and B lymphocyte purity of the graft exceeded 99.99%. Post-transplant course was favorable, the patient did not experience serious complications. Recovery of neutrophils on post-HSCT day +9 and platelet on day +12. Six months after stem cell transplantation, the patient's clinical symptoms significantly improved, the SLEDAI score dropped from 28 to 0, and the patient discontinued receiving immunosuppressive drugs. Conclusion: Autologous hematopoietic stem cell transplantation promises to be a new, effective therapeutic method that can be implemented more broadly in Vietnam for SLE patients.