Hematopoetic and mesenchymal stem cell transplantation in the treatment of refractory systemic lupus erythematosus--where are we now?

Cell based therapies are of increasing interest in the treatment of systemic lupus due to their potential for long term suppression or cure of disease. Two methods for stem cell transplantation are currently being investigated/performed for treatment of lupus. Autologous hematopoetic stem cell transplantation is used in patients refractory to standard therapy. The morbidity and mortality of the procedure limit its use to select patients. Results indicate 50% long term disease free survival. The technical difficulty of the procedure requires it to be performed only in experienced centers. Mesenchymal stem cell transplants are a new emerging therapy for the treatment of lupus. Studies in murine models of lupus provide evidence of efficacy with safety. Limited uncontrolled trials in humans provide evidence of efficacy as well. Controlled trials are needed to assess the efficacy of both these therapies compared to standard therapy.