Autologous Hematological Stem Cell Transplantation For Systemic Sclerosis In Israel

Background: Autologous hematological stem cell transplantation (HSCT) is a novel therapy for systemic sclerosis (SSc) that has been validated in three randomized controlled trials.Objectives: To report the first Israeli experience with HSCT for progressive SSc and review the current literature.Methods: Five SSc patients who were evaluated in our department and were treated by HSCT were included. Medical records were evaluated retrospectively. Demographic, clinical, and laboratory data were recorded. Continuous data are presented as the mean +/- standard deviation. Categorical variables are presented as frequencies and percentages.Results: Five SSc patients were treated with HSCT. Four patients were adults (mean age 53 +/- 12 years) and one was a 12-year-old pediatric patient. All patients were female. HSCT was initiated 1.4 +/- 0.8 years after diagnosis. Two patients were RNA POLIII positive, two were anti-topoisomerase 1 positive, and one only antinuclear antibodies positive. All patients had skin and lung involvement. The mean modified Rodnan Skin Score was 29 +/- 4.7 before HSCT, which improved to 10.4 +/- 9.6 after HSCT. The forced vital capacity improved from 68 +/- 13% to 90 +/- 28%. Diffusing capacity of the lungs for carbon monoxide increased by 6%. Among severe adverse events were cyclophosphamide-related congestive heart failure, antithymocyte globulin-related capillary leak syndrome, and scleroderma renal crisis. All symptoms completely resolved with treatment without sequela. No treatment related mortality was recorded.Conclusions: HSCT is an important step in the treatment of progressive SSc in Israel. Careful patient selection reduces treatment related morbidity and mortality.