First manifestations of seronegative spondylarthropathy following autologous stem cell transplantation in HLA-B27-positive patients

Koch, Babette; Kranzhöfer, N; Pfreundschu, M; Pees, H. W.; Trümper, L.

doi:10.1038/sj.bmt.1702565

Cited by 20 publications

(9 citation statements)

References 14 publications

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“…reported complete clinical remission in active ankylosing spondylitis following chemotherapy and autologous stem cell transplantation for lymphoma [4]. However, the development of rheumatologic manifestations, such as arthralgias and arthritis, have been reported following allogeneic bone marrow transplantation or peripheral blood stem cell transplantation [5]. Some cases of hematological malignancies were preferentially expressed in HLA-B27 carriers [6].…”

Section: Discussionmentioning

confidence: 99%

Regression of syndesmophyte after bone marrow transplantation for acute myeloid leukemia in a patient with ankylosing spondylitis: a case report

et al. 2012

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IntroductionDisease progression of ankylosing spondylitis has been considered irreversible. However, we report a case of spontaneous regression of syndesmophyte development following allogeneic peripheral blood stem cell transplantation in a patient with acute myeloid leukemia, who was also diagnosed as having ankylosing spondylitis. To the best of our knowledge, this is the first case report presenting the partial radiologic regression of syndesmophytes.Case presentationA 39-year-old man with active ankylosing spondylitis achieved clinical remission and partial radiological regression of cervical spine syndesmophytes following a peripheral blood stem cell transplantation for acute myeloid leukemia. Our patient received an allogeneic peripheral blood stem cell transplantation following a pre-transplantation conditioning regimen of total body irradiation and cyclophosphamide. The donor was a human leukocyte antigen-matched 29-year-old man. Our patient has remained asymptomatic and has received no medication for ankylosing spondylitis for nearly three years.ConclusionsSeveral explanations are proposed for the regression of syndesmophytes and clinical improvement in active ankylosing spondylitis observed in our patient, including changes in bone remodeling and immune reconstitution following stem cell transplantation, the effect of immunosuppressive agents, or fluctuation in the natural course of ankylosing spondylitis although further studies are required. The regression of syndesmophytes in ankylosing spondylitis in this case raises the possibility that stem cell transplantation might contribute to the development of a novel therapeutic strategy for treatment of the disease.

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Section: Discussionmentioning

confidence: 99%

Regression of syndesmophyte after bone marrow transplantation for acute myeloid leukemia in a patient with ankylosing spondylitis: a case report

et al. 2012

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“…All three patients had enthesopathy and were subsequently tested positive for HLA-B27. The development of these SpA manifestations took between 4 and 15.5 years after SCT [90]. In 2010, another case report described the development of undifferentiated SpA in a 26-year-old male patient following allogeneic SCT.…”

Section: Complications Of the Use Of Stem Cells In Autoimmune Diseasesmentioning

confidence: 97%

Role of stem cells in spondyloarthritis: Pathogenesis, treatment and complications

Wong

2015

Human Immunology

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“…Stem cell transplantation because of lymphoma in a patient who also happened to have AS has been reported [56]; in another patient, SpA-like symptoms developed [57]. …”

Section: Radiation and Immunosuppressive Therapymentioning

confidence: 99%

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2002

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308Arthritis Research Vol 4 No 5 Braun and Sieper and sex-matched AS patients with severe disease were compared with RA patients with severe disease, the grades of pain and disability were similar [5]. Furthermore, absence from work and work disability is clearly greater in patients with AS than in individuals without the disease [6][7][8]. In a recent survey in the USA [9], the most prevalent quality-of-life concerns of patients with AS included stiffness (90.2%), pain (83.1%), fatigue (62.4%), poor sleep (54.1%), concerns about appearance (50.6%), worry about the future (50.3%) and side effects of medication (41%). Indeed, fatigue has been identified as a major problem in AS -closely associated with pain and stiffness [10]. However, many AS patients cope better with their disease than RA patients, possibly because of the earlier onset of AS and the somewhat better education in AS patients. In recent decades, patients, general practitioners and rheumatologists have arranged themselves a lot with the situation in AS, because that is what happens when there is no treatment available.Thus, SpA in general and AS especially are more prevalent than was previously thought and have a clear socioeconomic impact on society. Against this background, it is becoming increasingly clear that more effective therapies are needed. Although there is a role for intensive physiotherapy, as was recently shown [11,12], this review concentrates on the drug therapy of AS -the most prevalent subtype of SpA, and the one with the most severe outcome. Treatment of ankylosing spondylitis with nonsteroidal anti-inflammatory drugsNonsteroidal anti-inflammatory drugs (NSAIDs) and intraarticular coriticosteroids are accepted, often-used treatments for AS [13]. NSAIDs are taken, with varying efficacy, by about 70-80% of AS patients. A good response to NSAID treatment has even been suggested as a criterion for the diagnosis of inflammatory back pain and SpA [14]. A poor response or none to NSAIDs has been identified as a poor prognostic sign in AS [15,16]. Patients' responses to NSAIDs are broadly similar but nevertheless often differ markedly from one person to another. Several NSAIDs may therefore need to be tried to identify the best one for a particular patient, and high doses are often required in severe cases [16]. Indomethacin, naproxen and diclofenac are among those most frequently used in AS, but others clearly work also [17]. Finally, an almost historical but very effective agent, phenylbutazone (not available in the USA), may be tried by experienced rheumatologists for patients with severe AS [15,18].There is evidence that the new, more COX-2 selective drugs meloxicam and celecoxib [19,20] are no less effective in treating back pain of AS patients than conventional NSAIDs such as piroxicam and ketoprofen. The effectiveness of these newer drugs may be associated with the advantage of less serious gastrointestinal events.However, as in other rheumatic diseases, NSAIDs are valuable only to improve the symptoms of spinal inflammti...

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First manifestations of seronegative spondylarthropathy following autologous stem cell transplantation in HLA-B27-positive patients

Cited by 20 publications

References 14 publications

Regression of syndesmophyte after bone marrow transplantation for acute myeloid leukemia in a patient with ankylosing spondylitis: a case report

Regression of syndesmophyte after bone marrow transplantation for acute myeloid leukemia in a patient with ankylosing spondylitis: a case report

Role of stem cells in spondyloarthritis: Pathogenesis, treatment and complications

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