Autologous haematopoietic stem cell transplantation -: a meaningful therapy in autoimmune diseases?

Autologous transplantation of haematopoietic stem cells has in recent years greatly widened the scope of therapeutic possibilities in haematological and oncological diseases and is now routinely practised in many clinical centres. Mortality associated with transplantation has been steadily lowered and is now clearly below 5% so that it appears ethically justified to employ this procedure even if a disease is primarily non-lethal. There are many reasons in favour of evaluating autologous stem cell transplantation even in rheumatic systemic diseases, such as the still considerable morbidity and mortality of the mostly chronically progressive autoimmune diseases, lack of curative approaches, and successes achieved via more aggressive (more intensive) immuno-suppression. Data from animal experiments, historical experiences with allogenic transplantation in patients with haematological diseases and concomitant autoimmune disease, as well as initial experiences with autologous stem cell transplantation, especially in the treatment of sclerodermia, seem to indicate that this may indeed be a promising therapeutic concept.