PERIPHERAL BLOOD CD34+ CELL MOBILIZATION IN 42 PATIENTS WITH SEVERE AUTOIMMUNE DISEASE.

Objective: To evaluate the feasibility and safety of peripheral CD34* cell mobilization in patients with severe auto-immune disease. Methods: Forty-two patients underwent a total of 46 mobilizations by the regimen of cyclophosphamide 2-3 g/m2 + recombinant human granulocyte colony stimulating factor (rhG-CSF) 5 μg ∙ kg -1 ∙ d -1. The positive selection of CD34+ cell was performed through the CliniMACS. Results: In 8.1 ± 2.3 days after administration of cyclophosphamide, the peripheral white blood cell and mononuclear cell (MNC) decreased to the lowest level In 3.7 ± 1.6 days after injection of rhG-CSF, the peripheral absolute MNC and CD34+ cell counts were 0. 95 x 109/L and 0.035 x 109/L, respectively. After 2.4 ± 0.6 times of leukapheresis, there gained 4.46 x 108/kg of MNC and 5.26 x 106/kg of CD34 , respectively. After mobilization, the underlying diseases were ameliorated more or less. In systemic lupus erythematosus (SLE) patients, SLE Disease Activity Index (SLEDAI) decreased from a median of 17 to 3 (P <0. 01). In rheumatic arthritis patients, an American College of Rheumatology criteria for 20% (ACR2O) response was achieved in all five patients. Totally, 17. 4% of patients whose absolute neutrophil count <0.5 x 109/L suffered infection, and 31. 0% of patients had bone pain after the injection of rhG-CSF. Two patients suffered severe complications, one with acute renal failure and recovered by hemodialysis, the other died of thrombotic thrombocytopenic purpura. Failed mobilization occurred in three patients. Conclusions: Sufficient CD34 cells can be mobilized by low dose of cyclophosphamide and rhG-CSF. CD34+ cell mobilization for treatment of severe autoimmune disease not only is appropriate in both effectiveness and safety but ameliorates disease also. [ABSTRACT FROM AUTHOR]