Dr John Carter: Stem Cell Transplant for Scleroderma

In a European trial to treat systemic scleroderma patients with stem cell transplants, about 10% of people died from the treatment.

Dr John CarterThe survival rate after 5 years was about 80% and 65% for those who did not have a transplant. After 10 years it was about 70% and 50% respectively. Dr John Carter, consultant haematologist at Wellington Hospital’s blood and cancer centre, talked about st      em cell transplants generally: what they are, how they work and how they can be effective.

His speciality is stem cell transplants. He declared at the outset of his talk to the seminar that such procedures, while common in the treatment of blood cancers, are rarer for scleroderma.

He says scleroderma is difficult to treat as it can involve lung, heart, skin and joints. Perhaps reflecting the difficulty, figures for the US in 2011 showed that of nearly 20 thousand stem cell transplants, categorised by disease, scleroderma was lumped in with “other”, which totalled fewer than 500.

Doctors trying to kill cancer cells or correct the misdirected immune process obliterate them with high-dose radiation, in combination with chemotherapy. Stem cells die too in the treatment but are reintroduced by a transplant. The theory is that the transplanted supply of stem cells will repopulate the body with healthy cells and end the disease. Transplants are common in the treatment of blood cancer sufferers.

For those who have the treatment early in their disease, the survival rate after 6 years is about 60%. It decreases for those treated with more sever or advanced symptoms, the extreme of which is 20% survival after 6 years. Dr Carter says the mortality rate from the transplants alarms rheumatism and autoimmune specialists who are unused to such a toll. Stem cells produce immune cells but they make up just 1% of the body’s cells.

Dr Carter says the modern way to retrieve stem cells is to extract them from blood. Stem cells can be sourced from a patient’s own blood, from siblings or unrelated donors. In earlier years doctors sucked them from the pelvic bones using large needles in a short but painful procedure.

The blood stem cells used are CD34 positive cells. Dr Carter says use of stem cell transplants to treat autoimmune diseases like scleroderma, multiple sclerosis and Crohn’s disease could be performed in New Zealand but the rheumatologist or other specialist would need to recommend it. Some Kiwis travel overseas to have it done. It’s not cheap. In Moscow, it can be had for $US40 thousand, in Singapore for $US 80 thousand and in the United States, $US200 thousand.