Autologous hematopoietic stem cell transplantation for refractory Crohn's disease

Abstract

Despite recent advances in Crohn’s disease (CD) therapy, with ever-new treatments available, there is still a relevant percentage of patients with refractory disease who do not achieve adequate clinical response and are not amenable to intestinal surgery. A joint consensus of the European societies for blood and marrow transplantation and inflammatory bowel disease has recognized the therapeutic role of autologous hematopoietic stem cell (HSCs) transplantation in this cluster of patients. The therapy produces a reset of patients’ immune system and the subsequent recovery of more self-tolerant inflammatory cells. In several case series and prospective clinical trials, this treatment was demonstrated to be able to induce clinical remission and heal mucosal damage, although providing only a temporary improvement. The use of deep immunosuppression as part of transplanting protocols represents the major limitation of this technique as causes a high adverse event rate, including mortality of up to 2%. Many new protocols have been assessed and are under investigation with the intent to reduce complications. The present review summarizes evidence of the efficacy and safety of autologous HSCs transplantation in refractory CD.

Keywords

• Transplant. Crohn. Refractory. Hematopoietic.