Low-dose total body irradiation in rheumatoid arthritis

New therapeutic aspects: haemopoietic stem cell transplantation

Primary systemic vasculitis responds well to intensive immunosuppression, particularly with cyclophosphomide. Use of the latter is restricted by side-effects, particularly in relapsing disease. Techniques which allow more complete immunosuppression have an obvious attraction in autoimmune disease. They are particularly suitable for vasculitis which can go into long-lasting remission even with standard therapy in many cases. The conditioning used for stem cell transplantation allows more complete deletion of auto aggressive T-cell clones, with subsequently haemopoietic rescue by previously harvested stem cell precursors. The procedure also has immune potentiating effects, perhaps by promoting peripheral suppressor mechanisms. These may be important even though immune ablation is not achieved. With rigorous patient selection, experience with this technique in vasculitis may be broadened.