Currently used protocols and proposed new protocol of autologous stem cell transplantation for juvenile idiopathic arthritis
| Protocol | Conditioning | TCD | Follow up (months) | Inclusion criteria | Exclusion criteria | Supportive care |
|---|---|---|---|---|---|---|
| ASCT, autologous stem cell transplantation; ATG, anti-thymocyte rabbit immunoglobulin (SangStat, Fremont, California, USA); CD2/3, negative selection by monoclonal antibodies to CD2 or CD3 positive lymphocytes; CD34, positive selection of CD34+ stem cells; Cy, cyclophosphamide; Flu, fludarabin; IVIG, intravenous immunoglobulin; PCP, Pneumocystis carinii pneumonia; TBI, total body irradiation; TCD, T cell depletion; TNF, tumour necrosis factor; VCR, ex vivo T cell depletion using vincristine. | ||||||
| A | Cy, ATG, TBI (low dose, 4 Gy) | CD2/3 or CD34 | 60 | Drug resistant, including anti-TNF | Cardiorespiratory insufficiency, chronic infections, active systemic disease at time of ASCT, end stage disease, poor compliance | No specific rules for IVIG or antimicrobial prophylaxis |
| B | Cy, ATG | CD34 | 42 | |||
| C | Cy, Flu, ATG | VCR or CD34 | 24 | |||
| Proposed new protocol | Cy (50 mg/kg/d at day −4 and −1) | CD34 selection | Same as above | Same as above | Isolation during aplastic period | |
| ATG 5 mg/kg/d at day −8 to day −5) | CD34>1×106/kg and add back CD3 1×105/kg | IVIG (0.4 mg/kg × 3 weeks) until CD3 count >500/μl | ||||
| Reinfusion of stem cells at day 0 | Pentamidine (PCP prophylaxis, avoid cotrimoxazol) | |||||