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To investigate the effects of high dose chemotherapy (HDC) and autologous stem cell transplantation (ASCT) on the synovial infiltrate in rheumatoid arthritis.
8 patients with erosive, refractory, progressively rheumatoid arthritis, were treated with HDC (cyclophosphamide 200 mg/kg) and CD34 enriched selected ASCT. Biopsies of synovial tissue from a clinically involved knee were obtained by arthroscopy before and three months after HDC and ASCT. Immunohistochemistry was performed and blindly scored on a five point scale (0-4) using MoAbs specific for the following markers: CD3, CD4, CD8, CD25, CD27, CD45RA, CD45RO, CD45RB, CD19, CD20, CD22, CD38, CD5, CD68, HLA-DR, CD62L, CD62E, CD56 and CD55.
There were no statistical significant differences (Wilcoxon's signed rank test) when the results before and after transplantation were compared. However when patients were divided in clinical responders (ACR > 50%, n = 5) and non-responders (ACR < 20%, n = 3) statistically significant differences with respect to several T-cell markers were found (Table).
There was a statistically significant difference (P < 0.05) between clinical responders and non-responders with respect to a decrease in infiltration of CD45RA+ and CD45RO+ cells after HDC and ASCT. CD27, CD45RO and CD45RB appear to be useful markers to predict clinical response.