Prolonged remission without treatment after autologous stem cell transplantation for refractory childhood systemic lupus erythematosus

In systemic lupus erythematosus renal involvement is more frequent in children than in adults. Overall, 60-80% of children with systemic lupus erythematosus have urinary or renal function abnormalities early in the disease course. In 90% of patients, renal disease occurs within two years from disease onset. Clinically significant renal involvement ranges from asymptomatic urinary findings to nephrotic syndrome and renal failure. Long-term prognosis is similar to that observed in adults. Treatment aspects that are peculiar to children include drug side-effects, such as growth inhibition induced by steroids, the need to consider morbidity-related issues with respect to the very long life expectancy of patients and the problems related to the impact of disease in adolescents. The recent availability of a childhood SLE definition of improvement and the presence of large international paediatric rheumatology networks should, in the future, facilitate the implementation of controlled clinical trials devoted to paediatric SLE.

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“…Remissions in refractory cases after autologous bone marrow transplantation have been reported also in children. 34 …”

Section: Treatmentmentioning

confidence: 99%

Lupus nephritis in children

Perfumo

Martini

2005

Lupus

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“…Prolonged remission without treatment after autologous stem cell transplantation has been reported in children with refractory childhood systemic lupus erythematosus [54,55]. However, we consider that the autologous stem cell transplantation's toxicity limits its indication in childhood SLE and that this "very last chance" therapeutic option should be considered only when all other strategies failed.…”

Section: Autologous Marrow Stem-cell Transplantationmentioning

confidence: 97%

Childhood Systemic Lupus Erythematosus: New and Old Treatments

Bader‐Meunier¹,

Haddad

2006

CPR

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Systemic lupus erythematosus (SLE) is more severe in children than in adults, and often needs aggressive treatment. Classical (old ) therapies include mostly non-steroid anti-inflammatory drugs, hydroxychloroquine, corticosterois and cyclophosphamide. However, these two latter drugs can induce severe side effects. Recently, new drugs, especially Mycophenolate Mofetyl and anti-CD20 antibody, have been proved to be efficient and well tolerated in adult-onset SLE and may become mainstay therapeutic option for severe chidhood-onset lupus manifestations. Management of complications such as growth failure, osteoporosis, premature atherosclerosis and anti-phospholipid syndrome has also progressed within the last years. Beside these promising perspectives of treatment, psychological support, long-term follow-up and program of transition from the pediatric to the adult care unit remain essential.

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“…Wulffraat et al [52] described the results of this procedure in two adolescents with SLE who achieved complete remission for 9 to 12 months. HSCT can arrest disease progression and induce stable remission in selected patients, but is also associated with high morbidity and mortality, and long-term results are unknown.…”

Section: Hematopoietic Stem Cell Transplantmentioning

confidence: 99%

Autoimmune mechanisms in children with systemic lupus erythematosus

Stichweh

Pascual²

2005

Curr Rheumatol Rep

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Although the pathogenesis of SLE remains poorly understood, there is consensus that it involves a combination of genetic, hormonal, and environmental factors. New technologies applied to genomic and gene expression studies have revealed novel gene mutations and cytokine alterations in this disease. Recently, advances in monoclonal antibodies and recombinant DNA technology have resulted in the development of new drugs to arrest disease progression and restore physiologic immune responses without major side effects. Clinical trials to test several of these novel therapies are currently underway.

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Prolonged remission without treatment after autologous stem cell transplantation for refractory childhood systemic lupus erythematosus

Cited by 10 publications

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Lupus nephritis in children

Lupus nephritis in children

Childhood Systemic Lupus Erythematosus: New and Old Treatments

Autoimmune mechanisms in children with systemic lupus erythematosus

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