ABSTRACT
Autologous hematopoietic stem cell transplantation (HSCT) is being explored as therapy for autoimmune diseases including rheumatoid arthritis, multiple sclerosis, and systemic lupus erythematosus. Recently, our medical center performed the first four HSCTs in the world for patients with severe Crohn’s disease (CD), and the salutary response to therapy was dramatic. This chapter will review the immunology of the intestinal immune system and pathophysiology of CD. The natural history of CD and identification of high risk and refractory disease is described to counterpose the morbidity and mortality of CD with HSCT. CD therapy is discussed to show that standard therapies are symptomatic, directed at the manifestations of CD, rather than attempting to be curative and directed at the underlying cause. Finally, patients who have undergone bone marrow transplantations for other reasons, who incidentally had inflammatory bowel disease, and our first two patients are described.
