Cure for Lupus May Be in Sight
Aug. 25, 2000 -- Lupus patients near death have lost all signs of the disease after receiving an experimental stem cell transplant -- and normally cautious researchers are talking about a cure. The same type of stem cell transplant used to treat lupus also may help patients with multiple sclerosis, rheumatoid arthritis, and other diseases in which the immune system appears to attack the body.
There were only seven patients in the lupus study, conducted at Northwestern University in Chicago. But the results have been dramatic -- all the patients got better and stayed well for up to three years and counting.
"When we started, we thought that referring to even the possibility of a cure was absurd," study author Ann Traynor, MD, tells WebMD. "We thought that after treating patients at risk of death we would be happy to gain control of the disease and arrest their downward spiral. At this point, having followed them for this long ... it is conceivable that some of them will be cured."
Not all lupus experts agree that stem cell transplants are the answer. "First, we should back off -- this is still experimental," Doyt L. Conn, MD, director of rheumatology at Emory University School of Medicine in Atlanta, tells WebMD. "Stem cell transplants are not without real risks and have to be done by very sophisticated centers with highly trained staff. Most patients with lupus can be managed very well with [current treatments]. The number of patients that could be treated with something like this would be very small."
Lupus occurs when a type of immune cell in the blood -- known as a T cell -- gets carried away and tells the immune system to attack normal body tissues. The disease can range from a very mild skin rash -- treatable with mild drugs -- to life-threatening illness that requires very powerful and toxic drugs that suppress the immune system.
Traynor and colleague Richard K. Burt note that lupus is not a purely genetic disease, as the disease in one identical twin does not mean the other twin will develop the disease. They reasoned that if they could get rid of the T cells that had gone bad and replace them with naïve T cells -- or stem cells -- the new cells would not learn the destructive habits of their predecessors.
The transplant procedure is no walk in the park -- especially for people who are very ill. It requires that patients first receive treatment with a moderate dose of a powerful immune-suppressing drug to put their disease into temporary remission. Patients then get a treatment that makes their bone marrow produce stem cells, and these cells must be collected in a process that takes three or four days. When these naïve cells have been stored safely in a freezer, the patients then get three days of high-dose chemotherapy to clear the way for the stem cell transplant. They also get a horse serum that kills off all of their T cells.