Abstract: TH-OR033

Autologous Hematopoietic Stem Cell Transplantation for Refractory Lupus Nephritis

Session Information

Category: Chronic Kidney Disease (Non-Dialysis)

  • 305 CKD: Clinical Trials and Tubulointerstitial Disorders

Authors

  • Huang, Xiang-hua, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing China, Nanjing, China
  • Chen, Wencui, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing China, Nanjing, China
  • Hu, Weixin, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing China, Nanjing, China
  • Liu, Zhi-Hong, National Clinical Research Center of Kidney Diseases, Jinling Hospital, Nanjing University School of Medicine, Nanjing China, Nanjing, China
  • Ren, Guisheng, Jinling Hospital, Nanjing, China
Background

To evaluate the efficiency and safety of the treatment of autologous hematopoietic stem cell transplantation (ASCT) for patients with refractory lupus nephritis (LN).

Methods

From Jul 2011 to Jan 2015,a total of twenty-two patients with refractory LN relapse or had no response to standard immunosuppressive therapies were enrolled in this study.Peripheral blood stem cells were mobilized with cyclophosphamide ( CTX) and granulocyte colony-stimulating factor ( G-CSF),and reinfused after treatment with CTX and antithymocyte globulin(ATG). The primary end point was remission rate,and secondary end points included the survival and relapse rate, changes in proteinuria, renal function and serology immunologic test. All the complications were recorded for safety access.

Results

Twenty-two patients were enrolled and underwent stem cell mobilization. They were 9 males and 13 females with a median LN duration of 45.5(33-71) months. The mean number of CD34+ cells was ( 7. 3 ± 3.8) × 106 /kg. All patients had successful engraftment,and the median time of granulocyte and platelet engraftment was 8 and 9 days, respectively.The major complications of ASCT were fever and symptom of gastrointestinal tract. The treatment-related mortality was 4.5% ( 1/22). After a median follow-up of 53 months,eighteen patients (81.8% ) achieved completed remission,one patient (4.5%) achieved partial remission,and one had no response and received peritoneal dialysis at 12 months after ASCT. One patient died for sepsis at 5 month after ASCT. The median time of renal response was 3 months. The 5-years overall survival was 90%.The probability of disease-free survival at 5 years following ASCT was 52.9%. Six patients had relapse during the follow-up and the relapse rate was 27.3%.

Conclusion

Our preliminary data shows that ASCT is a safe and effective treatment of refractory LN, the completed response rate was high and the complications was manageable. Infection is still an important cause of treatment failure, the long-term efficacy still need further observation.