Autologous hematopoietic stem cell transplantation improves long term survival – data from a national registry

Abstract:BackgroundCurrent recommendations on the management of systemic sclerosis (SSc) suggest that autologous hematopoietic stem cell therapy (HSCT) can be a rescue therapy for patients with rapidly progressive SSc. Objectives To assess safety and efficacy of HSCT for patients with SSc and to compare these with non-HSCT patient in a control cohort with adjusted risk factors.MethodsA retrospective analysis of data from the multicentric German network for systemic scleroderma (DNSS) with 5000 patients with SSc. Control groups consisted of all patients with diffuse cutaneous (dc)-SSc (group A) and an adjusted high risk cohort of male patients with Scl70-positive dc-SSc (group B).ResultsEighty SSc patients received an HSCT 4.1 ± 4.8 years after SSc diagnosis. Among them 86.3% had dc-SSc, 43.5% were males, and 71.3% were positive for Scl70 antibodies. The control group A showed a significant underrepresentation of these risk factors for mortality. When the survival of the control group B was compared with the HSCT group, a lower mortality of the latter was observed instead. Within 5 years after HSCT, we observed an improvement of the mRSS from 17.6 ± 11.5 to 11.0 ± 8.5, and an improvement of the DLCO from 54.6 ± 17.8% to 60.0 ± 18.5%. We did not see differences in transplant-related mortality between patients who received HSCT within 3 years after SSc diagnosis or later.ConclusionOur analysis of real life data show that the distribution of risk factors for mortality is critical when HSCT cohorts are compared with non-HSCT control groups.