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Old 06-26-2018, 11:19 AM
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Default HSCT for autoimmune diseases – Clinical experience and mechanisms

Journal of Autoimmunity
Available online 20 June 2018

Hematopoietic stem cell therapy for autoimmune diseases – Clinical experience and mechanisms

Tobias Alexandera, , , Dominique Fargeb, c, Manuela Badogliod, James O. Lindsaye, f, Paolo A. Murarog, John A. Snowdenh

•HSCT has the potential to induce sustained clinical remissions in autoimmune diseases (AD) by restoring self-tolerance.
•The majority of procedures are autologous HSCT, with an evolving base in MS, systemic sclerosis and Crohn’s disease.
•The principle of HSCT is based on depletion of the pathogenic autoreactive repertoire and enabling immunologic renewal.
•Immunologic renewal provides a diverse repertoire of naïve T- and B-cells, including restoration of regulatory cells.
•HSCT requires careful patient selection and multidisciplinary team working between hematology and AD specialists.

With accumulating evidence and improved outcomes along with recognition that modern biological therapies are not universally effective, require chronic administration and have high acquisition costs, hematopoietic stem cell transplantation (HSCT) has become an emerging direction for cell therapy in autoimmune diseases (ADs).

The goal of this therapy is to induce medication-free remissions by resetting the immune system into a naïve and self-tolerant state through eradication of the autoreactive immunologic memory and profound re-configuration of the immune system induced by the transplant procedure. Safety of HSCT has generally improved by implementing internal quality management and external accreditation. Inter-disciplinary guidelines for patient selection, transplant technique and supportive care along with greater center experience should optimize safe and appropriate delivery of HSCT in specific ADs.

In this review, we discuss the current role and future perspectives of HSCT in AD, focusing on recent published clinical and scientific studies and recommendations in the field.
Dave Bexfield
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