Immune Ablation Followed by Stem Cell Transplantation (Allogeneic) or Support (Autologous) for Severe Autoimmune Diseases

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Abstract
The concept of autogenes has been proposed recently, and experimental autoimmune diseases have been considered as “polyclonal stem cell diseases”. Autoantibodies, particularly in the autoimmune rheumatic diseases, are antigendriven, and it has been demonstrated that there is clear dependence on the presence of the antigen itself in giving rise to the autoantibodies. Autoimmune thrombocytopenia in the recipients may derive from the donor, may develop in the context of chronic graft-versus-host disease, and may supervene in a primitive fashion, that is idiopathically, following both allo- and auto-bone marrow transplantation. The postulated autoimmune condition with the highest number of performed transplants is rheumatoid arthritis. For almost all patients the reason for transplantation was iatrogenic, gold-related SAA. A female patient with a clinical picture highly suggestive of SLE (arthralgias, malar rash, pleuritis, alopecia, antinuclear antibodies of unreported pattern) developed SAA and was transplanted from her human leukocyte antigen (HLA)-identical ABO matched brother.

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