Pasquini MC et al. Transplants for Autoimmune Diseases in North and South America: A Report of the Center for International Blood and Marrow Transplant Research (CIBMTR). Biol Blood Marrow Transplant. 2012 Jun 12. [Epub ahead of print]
Haematopoietic cell transplantation (HCT) is an emerging therapy for severe autoimmune diseases (AID). We report data on 368 patients with AID receiving HCTs in 64 North and South American transplant centers reported to the Center for International Blood and Marrow Transplant Research (CIBMTR) from 1996 through 2009.
Most transplants are autologous (the transplant is from yourself to yourself) grafts (N=339); allogeneic (transplant from someone else and so carriers a risk of rejection or causing Graft verse Host disease)HCTs (N=29) were mostly in children.
The most common indications are multiple sclerosis (MS), systemic sclerosis (SSC) and systemic lupus erythematous (SLE). Median (the middle) ages at transplantation are 38 and 25 years for autologous and allogeneic HCT, respectively. Corresponding times from diagnosis to transplantation are 35 and 24 months. Three-year overall survival after autologous HCT is 86% (95% confidence interval [CI], 81-91%); median follow up of survivors is 31 months (range, 1-144 months). The most common causes of death are AID progression, infections and organ failure. In the multivariate analysis, risk of death was higher among patients at centers that performed <5(less than 5) (relative risk [RR] 3.5, 95% CI 1.1-11.1, p=0.03) and 5-15 (RR 4.2, 1.5-11.7, p=0.006) autologous HCT compared to patients at centers that performed >15 (more than fifteen) autologous HCT for AID during the study period. AID is an emerging indication for HCT in the region. Collaboration of haematologists and other disease specialists with an outcomes database is important to better understand optimal patient selection, impact of prognostic variables, analysis of long term outcomes, and development of clinical trials.
Bone marrow transplantions is a way to replace your immune system. You destroy the existing immune system with drugs and then transplant bone marrow. This is where white blood cells are made. This is a risky procedure and at one point had about a 5-8% risk of death from the procedure. This has dropped, but this study in the Americas indicate that if you are undergoing this procedure, it is better to have it done where there is experience in performing the technique as there is a 3-4 time more chance of death if you have the procedure done at a centre who have done less than 15 procedures compared to those places that have done more than 15.