Hematopoietic stem cell transplantation in a severe refractory Crohn’s disease patient with intestinal stoma: a case report
Received 13 April 2017
Accepted for publication 25 August 2017
Published 24 October 2017 Volume 2017:10 Pages 353—359
Checked for plagiarism Yes
Review by Single-blind
Peer reviewers approved by Dr Colin Mak
Peer reviewer comments 3
Editor who approved publication: Professor Ronald Prineas
Milton Artur Ruiz,1 Roberto Luiz Kaiser Junior,2 Luiz Gustavo de Quadros,2 Gustavo Henrique Xavier Caseiro,2 Aderson Francisco Oliveira,1 Tatiana Peña-Arciniegas,1 Lilian Piron-Ruiz,1 Fernanda Soubhia Liedtke Kaiser,2 Vera Lucia Oliveira2
1Bone Marrow Transplant Department, Associação Portuguesa de Beneficencia de São José do Rio Preto, 2Kaiser Clinica, Centro Médico Avançado de São José do Rio Preto, Sao Paulo, Brazil
Background: Hematopoietic stem cell transplantation (HSCT) can be used in the treatment of patients with refractory Crohn’s disease (CD) when no alternative treatment is available. However, HSCT increases the risk of infections, in particular during the aplasia of mobilization and conditioning. Moreover, intestinal stomas in CD augment the risk of morbidity in immunocompromised patients and under aplastic conditions. The objective of this report was to describe the results of the first year after HSCT in a CD patient with an intestinal stoma.
Methods: The patient was assessed in respect to disease symptoms and endoscopic findings before the procedure and 30, 90, 180, and 365 days after HSCT.
Results: No complications were observed during mobilization and conditioning with sufficient CD34+ cells being harvested in just one apheresis session. Toxicity was restricted to the hematological series. Scores of all the CD indexes and the quality of life of the patient improved. However, two of three endoscopic scores remained unchanged even though improvements were found in the appearance of the lesions.
Conclusion: HSCT may be an alternative treatment for refractory CD in patients with an intestinal stoma, and a priori, carefully selected patients with stomas should not be excluded as candidates for this procedure.
Keywords: Crohn’s disease, intestinal stoma, hematopoietic stem cell transplant, stem cell therapy, autologous HSCT, autoimmune diseases, nonmyeloablative HSCT
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