Complete remission of Crohn's disease after high-dose cyclophosphamide and autologous stem cell transplantation

In a 36-year-old male with ileocolic Crohn's disease ( CD) no long-lasting remission was obtained by treatment with corticosteroids, mesa lazine, azathioprine and antibiotics. Surgical interventions due to relapsing. stulae and abscesses resulted in the removal of >1.5m of small bowel and left only 40 cm of large bowel. In July 2000, a new. stula and abscess developed. The combination of corticosteroids, mesa lazine, ciprofloxacin, metronidazol, azathioprine, formula diet and anti-TNF-alpha antibody largely reduced clinical activity, and resection of. stula and abscess were successful. Despite clinical remission, histology showed activity in the small bowel and the colon. In March 2001, stem cell mobilization chemotherapy with cyclophosphamide was performed. It induced an endoscopic remission for 9 months, which was maintained on azathioprine and corticosteroids. After relapse, in March 2002, high-dose chemotherapy with cyclophosphamide and reinfusion of T-cell-depleted autologous peripheral CD34+ blood stem cells were performed. This led to a complete clinical, en doscopical and histological remission for 9 months without any treatment. Thereafter, endoscopy showed initial aphthous lesions with minimal histological signs of inflammation. The patient is asymptomatic, but low-dose prednisolone and methotrexate are prophylactically given. Immunoablative chemotherapy followed by autologous peripheral blood stem cell transplantation may be a beneficial therapeutic option in complicated refractory CD.