Hematopoietic Stem-Cell Transplantation for Systemic Lupus Erythematosus

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Abstract
A 24-year-old woman received the diagnosis of systemic lupus erythematosus at 11 years of age. Since then, she has had episodic flares characterized by fatigue, fever, malar rash, arthralgias, abdominal pain, and lupus nephritis. Dialysis and mechanical ventilation have been required intermittently, and she has been treated with plasmapheresis, corticosteroids, hydroxychloroquine, methotrexate, azathioprine, and cyclophosphamide, none of which allowed a tapering of prednisone to a dose of less than 20 mg a day. Since the age of 11 years, her hemoglobin level has ranged from 6.5 to 7.2 mg per deciliter (4.0 to 4.5 mmol per liter), her white-cell count has ranged from 2000 to 2400 per cubic millimeter, and her platelet count has been approximately 100,000 per cubic millimeter. Assays of C3, antinuclear antibodies, and anti–double-stranded DNA antibodies have never had normal results, even during clinical remissions.

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