Published online Oct 26, 2020. doi: 10.4252/wjsc.v12.i10.1113
Peer-review started: May 2, 2020
First decision: May 24, 2020
Revised: July 8, 2020
Accepted: August 25, 2020
Article in press: August 25, 2020
Published online: October 26, 2020
Processing time: 176 Days and 14.4 Hours
Crohn's disease (CD) is a chronic inflammatory bowel disease that can affect any part of the gastrointestinal tract. The etiology of CD is unknown; however, genetic, epigenetic, environmental, and lifestyle factors could play an essential role in the onset and establishment of the disease. CD results from immune dysregulation due to loss of the healthy symbiotic relationship between host and intestinal flora and or its antigens. It affects both sexes equally with a male to female ratio of 1.0, and its onset can occur at any age, but the diagnosis is most commonly observed in the range of 20 to 40 years of age. CD diminishes quality of life, interferes with social activities, traumatizes due to the stigma of incontinence, fistulae, strictures, and colostomies, and in severe cases, affects survival when compared to the general population. Symptoms fluctuate between periods of remission and activity in which complications such as fistulas, strictures, and the need for bowel resection, surgery, and colostomy implantation make up the most severe aspects of the disease. CD can be progressive and the complications recurrent despite treatment with anti-inflammatory drugs, corticosteroids, immunosuppressants, and biological agents. However, over time many patients become refractory without treatment alternatives, and in this scenario, hematopoietic stem cell transplantation (HSCT) has emerged as a potential treatment option. The rationale for the use of HSCT for CD is anchored in animal studies and human clinical trials where HSCT could reset a patient's immune system by eliminating disease-causing effector cells and upon immune recovery increase regulatory and suppressive immune cells. Autologous HSCT using a non-myeloablative regimen of cyclophosphamide and anti-thymocyte globulin without CD34+ selection has been to date the most common transplant conditioning regimen adopted. In this review we will address the current situation regarding CD treatment with HSCT and emphasize the medical, ethical, and legal aspects that permeate the procedure in Brazil.
Core Tip: Hematopoietic stem cell transplantation (HSCT) is an alternative treatment for patients with Crohn's disease, which is severe and refractory to conventional treatments. Prolonged remissions are described with the autologous as in the allogeneic modality. In this review, we describe the rationale, justifications, and results of HSCT in studies from various locations. Unpublished data and results from a relevant series are described. The ethical and legal medical aspects that permeate compassionate treatment in Brazil are defined and presented.