Marina A. Coutinho

Six cases of leprosy associated with allogeneic hematopoietic SCT.

We report here the first six cases of leprosy associated with HLA-identical allogeneic SCT in different phases and with different findings and outcomes. Skin and peripheral nerves may be sites of leprosy associated with SCT, stressing the importance of differential diagnosis between leprosy and GVHD or drug reactions. Clinical manifestations of leprosy before or after transplantation did not influence the outcome of SCT in our cases.

Transplante de células-tronco hematopoéticas em doenças reumáticas parte 1: experiência internacional

In this review, we discuss the results of hematopoietic stem cell transplantation (HSCT) for severe and refractory rheumatic diseases performed abroad. We briefly review clinical and experimental basis for those transplants and the international results obtained in systemic lupus erythematosus (SLE) (33/50 complete remissions in the European registry with 10 relapses and 12 deaths, and 41 durable remissions in an American study with 2 deaths post-mobilisation and 4 deaths posttransplantation), adult rheumatoid arthritis (58/73 partial remissions with 85% of relapses and only one death in the European registry), juvenile idiopathic arthritis (18/34 durable remissions and 5 deaths in the European registry), systemic sclerosis (SSc) (46/50 responders in a multicentric European study with 35% of relapses and 23% of mortality, while in an US series, 4/19 patients died, 2 had progressive lung disease and all the survivors improved the skin scores and quality of life) and several other diseases, including vasculidities (9/15 complete responses in the European registry). We conclude that in the international experience, autologous HSCT induces sustained remission in most severe and refractory rheumatic diseases except for adult rheumatoid arthritis, and this finding justifies starting prospective randomized trials of HSCT compared to optimal conventional therapy.

Transplante de células-tronco hematopoéticas em doenças reumáticas. Parte 2: experiência brasileira e perspectivas futuras

In this review, we discuss the results of hematopoietic stem cell transplantation (HSCT) for severe and refractory rheumatic diseases performed in Brazil. We analyze preliminary results obtained in Brazil with autologous HSCT in anecdotal cases (N = 3) and in the cooperative protocol initiated in 2001 (N = 18). In 8 lupus nephritis patients there were 3 sustained remissions, 3 deaths, 1 mobilisation failure and 1 short follow-up; in 7 systemic sclerosis patients there were 3 sustained remissions after transplantation and 2 after mobilisation, 1 death before mobilisation and another after the first dose of the conditioning in an overlapping syndrome of SLE and SSc, and between 2 patients with vasculitis there was 1 sustained remission in Takayasus arteritis and another in Behcets disease. One patient with juvenile idiopathic arthritis was included in the protocol very recently. The follow-up of the patients varied from 0 to 48 months with a median of 29 months. We conclude the study with a discussion of future prospectives in developed countries, where randomized trials comparing transplantation with the best pharmacological therapy available have started recently, and in Brazil, where several adaptations of existing protocols are required and the cost of transplantation is much lower than that of new biological therapies.