In this review, we discuss the results of hematopoietic stem cell transplantation (HSCT) for severe and refractory rheumatic diseases performed in Brazil. We analyze preliminary results obtained in Brazil with autologous HSCT in anecdotal cases (N = 3) and in the cooperative protocol initiated in 2001 (N = 18). In 8 lupus nephritis patients there were 3 sustained remissions, 3 deaths, 1 mobilisation failure and 1 short follow-up; in 7 systemic sclerosis patients there were 3 sustained remissions after transplantation and 2 after mobilisation, 1 death before mobilisation and another after the first dose of the conditioning in an overlapping syndrome of SLE and SSc, and between 2 patients with vasculitis there was 1 sustained remission in Takayasu's arteritis and another in Behçet's disease. One patient with juvenile idiopathic arthritis was included in the protocol very recently. The follow-up of the patients varied from 0 to 48 months with a median of 29 months. We conclude the study with a discussion of future prospectives in developed countries, where randomized trials comparing transplantation with the best pharmacological therapy available have started recently, and in Brazil, where several adaptations of existing protocols are required and the cost of transplantation is much lower than that of new biological therapies.
hematopoietic stem cells; bone marrow transplantation; rheumatic diseases
