Autologous peripheral hematopoietic stem-cell
transplantation in a patient with refractory pemphigus

doi:10.1007/s11684-008-0036-8

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Front. Med. ›› 2008, Vol. 2 ›› Issue (2) : 191-194. DOI: 10.1007/s11684-008-0036-8

Autologous peripheral hematopoietic stem-cell transplantation in a patient with refractory pemphigus

SUN Ledong¹, SUN Jing¹, ZENG Kang¹, MENG Fanyi¹, DIAO Youtao¹, XU Dan¹, HUANG Liang¹, ZHAO Jie¹, Liu Qifa²

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Abstract

The aim of this study is to explore the effectiveness of autologous peripheral hematopoietic stem-cell transplantation in the treatment of refractory pemphigus. A 35-year-old male patient presented with a 4-year history of recurrent bullae on his trunk and extremities. The diagnosis of pemphigus was made on the basis of the clinical, histologic and immunofluorescence findings. The patient had shown resistance to conventional therapy with glucocorticoid and immunosuppressive agents. Two months before admission, he complained of hip joint pain. X-ray and CT scan revealed aseptic necrosis of the femoral head. Stem-cell mobilization was achieved by treatment with cyclophosphamide, granulocyte colony-stimulating factor (G-CSF) and rituximab. Peripheral blood stem cells were collected via leukapheresis and cryopreserved for later use. Immunoablation was accomplished by using cyclophosphamide (200 mg/kg; divided into 50 mg/kg on days -5, -4, -3, and -2), antithymocyte globulin (ATG; 10 mg/kg; divided into 2.5 mg/kg on days -6, -5, -4, and -3), and rituximab (1200 mg/d; divided into 600 mg/d on days 0 and 7). Autologous peripheral hematopoietic stem cell transplantation was followed by reconstitution of the immune system which was monitored by flow cytometry. The glucocorticoid was withdrawn immediately after transplantation. The pemphigus titer turned negative 6 weeks after transplantation and remained negative. The patient was in complete drug-free remission with no evidence of residual clinical or serological activity of pemphigus during 1 year of follow-up. The patient’s response suggests that autologous peripheral hematopoietic stem cell transplantation may be a potential “cure” for refractory pemphigus. However, further studies are needed to evaluate the risk-benefit ratio of this approach in patients with pemphigus showing resistance to conventional therapy.

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SUN Ledong, SUN Jing, ZENG Kang, MENG Fanyi, DIAO Youtao, XU Dan, HUANG Liang, ZHAO Jie, Liu Qifa. Autologous peripheral hematopoietic stem-cell transplantation in a patient with refractory pemphigus. Front. Med., 2008, 2(2): 191‒194 https://doi.org/10.1007/s11684-008-0036-8

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