Hämatopoetische Stammzelltransplantation bei Autoimmunerkrankungen – Wo stehen wir aktuell?

Zusammenfassung

Die autologe Stammzelltransplantation (aSCT) ermöglicht bei vielen, unterschiedlichen Autoimmunerkrankungen das Erreichen einer langfristigen Verbesserung oder gar Remission. Allerdings ist die Therapie mit einem therapieassoziierten Risiko verbunden. Die therapieassoziierte Mortalität (TRM) hängt maßgeblich von der Grunderkrankung, der damit verbunden Organbeteiligung, aber auch von der Erfahrung der transplantierenden Zentren ab. Über die Jahre hat sich die aSCT als Therapieoption vor allem bei den schweren, therapierefraktären Patienten und bei Krankheitsbildern ohne neue Therapiemöglichkeiten etabliert. Dies führt häufig dazu, dass Patienten diese Therapie erst (zu) spät angeboten wird. Je nach Krankheitsbild – besonders ausgeprägt bei der Systemischen Sklerose – bestehen zu diesem Zeitpunkt bereits schwere Organschädigungen, welche wiederum die TRM dtl. erhöhen. Für die Zukunft sollten daher bessere Prognosefaktoren definiert, sowie weniger toxischer Therapieregime etabliert werden.

Abstract

Autologous stem cell transplantation (aSCT) leads to long-term improvement or even remission in various autoimmune diseases. However, this treatment is associated with a risk. Treatment-related mortality (TRM) mainly depends on the underlying disease and the associated organ involvement, but also on the level of experience that transplantation centres have with aSCT. Over the years, aSCT has become an established treatment option, especially for patients with a severe treatment-refractory disease and in diseases for which there are no new treatment options. This often leads to the fact that patients are offered this treatment with delay or even too late. In some diseases, especially systemic sclerosis, severe organ damage is already present at that point in time, which, in turn, leads to a significant increase in TRM. Therefore, new and reliable prognostic factors should be defined and less toxic treatment regimes established for the future.

Schlüsselworte:

Hämatopoietische Stammzelltransplantation - Autoimmunerkrankung - Systemische Sklerose - Multiple Sklerose - chron. entzündliche Darmerkrankungen

Key words

hematopoietic stem cell transplantation - autoimmune disease - systemic sclerosis - multiple sclerosis - inflammatory bowel disease

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