Hematopoietic cell transplantation for Crohn’s disease; is it time?

Table 1 Allogeneic transplant cases

	Demographics& indicationfor HCT	DiseaseactivitybeforeHCT	Complicationsof IBD beforeHCT	IBD duration(yr)	Donortype	Conditioningtherapy	T celldeplet.
Ditschkowski et al[46] Total 11 patients CD-7 UC-4	Median age 41 Male: 5 Female: 6 CML: 9 AML: 1 MDS: 1	Inactive: 5 Low Act: 6	Fistulae: 3 Obstruction: 2 EIM: 2 Surgery: 4	Median: 10	HLA- identical sibling - 8 HLA- identical unrelated donor- 2 Mismatched unrelated donor- 1	TBI + Cy: 6 TBI + Cy + ATG: 1 TBI + Cy + ATG + thiotepa: 1 TBI + Cy + thiotepa:1 Busulfan + Cy: 2	Yes: 3 No: 8
Lopez-Cubero et al[47]	27 Male CML	Inactive	EIM	11	HLA- match brother	TBI + Cy	No
	27 Male CML	Active	Obstruction Fistula	5	HLA- match sister	TBI + Cy	No
	41 Male CML	Active	Surgery Fistula EIM	9	HLA- match sister	TBI + Cy	No
	41 Male CML	Active	Sclerosing cholangitis	8	HLA- match unrelated donor	TBI + Cy	No
	38 Male CML	Active	Surgery EIM, ↑ ALP	3	One antigen mismatched brother	TBI + Cy	No
	46 Male AML	Active	Sclerosing cholangitis	29	HLA- match sister	TBI + Cy	No
Talbot et al[48]	35 Male AML	Active	Surgery	7	HLA- match brother	TBI + Cy	No

ALP: Alkaline phosphatase; AML: Acute myeloid leukemia; ATG: Antithymocyte globulin; CD: Crohn’s disease; CML: Chronic myeloid leukemia; Cy: Cyclophosphamide; EIM: Extraintestinal manifestations; HCT: Hematopoietic cell transplantation; MDS: Myelodysplastic syndrome; TBI: Total body irradiation; UC: Ulcerative colitis; Act: Activity; deplet: depletion.

Table 2 Outcomes of allogeneic transplant cases

	GVHD	Duration ofimmunosuppressantpost HCT (mo)	Length of follow up(mo)	Remissionof CD	Ongoing CDmedication orimmunosuppressant
Ditschkowski et al[46]	Acute: 8 Chronic: 0	2 patients off immunosuppressants	3-117 Median 34	Yes: 6 No: 1	Not stated
Lopez-Cubero et al[47]	Acute and Chronic	10	183	Yes	No
	Acute and Chronic	70	119	Yes	No
	Acute	6	70 Died of suicide	No - recurrent d 545	Prednisone
	Acute and Chronic	18	101	Yes	No
	Acute and Chronic	48	54 Died of myocardial infarction	Yes	No
	Acute	Not detected	Died of septic shock d 97	Not detected	Not detected
	Acute	2	96	Yes	No

GVHD: Graft versus host disease.

Table 3 Autologous transplant cases

	Demographics & indicationfor HCT	Disease activitybeforeHCT	Complications of CD	Duration of CD(yr)	Mobilization Conditioning		T cell deplet	Length of follow-up(mo)	Remiss. of CD	Ongoing meds
Oyama[53]	21 Female CD	Active	Fistulae, Surgery	10	Cy + GCSF	Cy + ATG	Yes	37	Yes	No
	16 Male CD	Active	Fistulae, Obstruction, GR	7	Cy + GCSF	Cy + ATG	Yes	36	Yes	No
	38 Female CD	Active	Fissures, Obstruction, Surgery	20	Cy + GCSF	Cy + ATG	Yes	27	Yes	No
	27 Female CD	Active	Fistulae, EIM, Surgery	12	Cy + GCSF	Cy + ATG	Yes	25	No	Mtx, pred.
	35 Male CD	Active	Fistulae, Obstruction, Surgery	12	Cy + GCSF	Cy + ATG	Yes	24	Yes	No
	27 Female CD	Active	Fistula, Surgery	6	Cy + GCSF	Cy + ATG	Yes	20	Yes	No
	25 Male CD	Active	Perianal disease, Surgery	13	Cy + GCSF	Cy + ATG	Yes	17	Yes	No
	15 Male CD	Active	EIM, GR, Surgery	8	Cy + GCSF	Cy + ATG	Yes	16	Yes	No
	31 Female CD	Active	Perianal disease, EIM, Surgery	10	Cy + GCSF	Cy + ATG	Yes	14	Yes	No
	37 Male CD	Active	Perianal disease	6	Cy + GCSF	Cy + ATG	Yes	14	Yes	No
	16 Male CD	Active	Fistula, EIM	1.5	Cy + GCSF	Cy + ATG	Yes	7	Yes	No
	27 Male CD	Active	Perforation, EIM, Surgery	14	Cy + GCSF	Cy + ATG	Yes	7	Yes	No
Scime[58]	55 Male CD	Active	EIM	2	Cy + GCSF	Cy + ATG	Yes	5	Yes	No
Kreisel[59]	36 Male CD	Active	Fistulae, Abscess, Surgery	14	Cy + GCSF	Cy	Yes	10	Yes	Mtx, pred.
Soderholm[52]	57 Female AML	NS	Obstruction, Fistula, Surgery	NS	NS	Cy + TBI	No	60	Yes	No
Musso[60]	30 Male Hodgkin’s Lymph.	Active	Surgery	10	Cy + GCSF	Idarubicin Melphalan	NS	39	Yes	No
Kashyap[51]	20 Male NHL	NS	Perianal disease, Obstruction, Surgery	8	DHAP	Cy + TBI + VP-16	No	84	Yes	No
Castro[50]	Age NS, Female Breast ca	Active	NS	11	NS	NS	NS	36	Yes	Asacol
Drakos[49]	41 female NHL	Inactive	Fistula, Surgery	22	NS	BCNU + VP- 16 + Cy + Ara-C + melphalan	NS	6	Yes	No

AML: Acute myeloid leukemia; ATG: Antithymocyte globulin; BCNU: Carmustine; CD: Crohn’s disease; Cy: Cyclophosphamide; D: Duration of Crohn’s disease in years; DHP: Dexamethasone, high dose Ara-C, platinum; EIM: Extraintestinal manifestation; GR: Growth retardation; NHL: Non Hodgkin’s lymphoma; NS: Not stated; TBI: Total body irradiation. VP-16: Etoposide; Mtx: Methotrexate; pred: prednisone; Remiss: Remission; meds: medications; deplet: depletion.