RESEARCH - Long-term followup of patients with severe RA after HDC followed by autologous HSCT

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Arthritis Rheum. 2005 Aug;52(8):2272-6.

Long-term followup of health status in patients with severe rheumatoid

arthritis after high-dose chemotherapy followed by autologous hematopoietic

stem cell transplantation.

Teng YK, Verburg RJ, Sont JK, Van Den Hout WB, Breedveld FC, Van Laar JM.

Leiden University Medical Center, Leiden, The Netherlands.

OBJECTIVE: High-dose chemotherapy (HDC) followed by autologous hematopoietic

stem cell transplantation (HSCT) is a new treatment for patients with

severe, refractory rheumatoid arthritis (RA). The present study was

undertaken to assess the health status of patients with severe RA over a

long-term followup period after treatment with HDC + HSCT. METHODS: Health

status and utility scores were assessed in 8 patients before and after

treatment with HDC + HSCT. Patients were followed up for 5 years

posttransplantation. Health status was assessed by the Health Assessment

Questionnaire (HAQ), the RAND-36 version of the Short Form 36 (SF-36) health

survey, and the Arthritis Impact Measurement Scales (AIMS). Utility scores

were calculated using the EuroQol (EQ-5D) questionnaire and the

SF-36-derived utility index (called the SF-6D), from which quality-adjusted

life years (QALYs) were derived. RESULTS: Most measures of health status

improved compared with baseline in the first 2 years posttransplantation,

notably HAQ and AIMS scores and scores on the functional status, general

health, and health change summary scales of the RAND-36 version of the

SF-36. Utility scores derived from the EQ-5D questionnaire and the SF-6D

also increased significantly after transplantation. This was reflected in

the 0.28 QALYs gained compared with baseline. For a putative 50-year-old RA

patient with a life expectancy of 20 years, a threshold analysis revealed

that HDC + HSCT yielded more QALYs than conventional therapy when

treatment-related mortality (TRM) was <2.8%.

CONCLUSION: HDC + HSCT temporarily increased the functionality and health

status of patients with severe, refractory RA. With a reported TRM of 1.3%,

HDC + HSCT can be considered a realistic treatment option for patients with

severe RA.

PMID: 16052541

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve & db=PubMed & list_uids=1\

6052541 & dopt=Abstract

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