Summer 2020 (Volume 30, Number 2)
Autologous Hematopoietic Stem Cell
Transplantation for Systemic Sclerosis in Canada
By Murray Baron, MD, FRCP(C)
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Autologous hematopoietic stem cell transplant (AHSCT)
has become an acceptable treatment option
for systemic sclerosis (SSc). Two recently published
trials, ASTIS and SCOT, have shown improved survival, more
skin softening and improved pulmonary function after
AHSCT compared to immunosuppressive therapy.
Canadian and Australian scleroderma experts have developed
a
new set of inclusion/exclusion criteria that can
act as guide to help Canadian rheumatologists decide if a
patient may be a good candidate for transplant. These criteria
are included on the Canadian Scleroderma Research
Group (CSRG) website at canadiansclerodermaresearchgroup.org/stem-cell-transplantation-criteria. Most of the criteria
are based on the results of a large Delphi survey of SSc
experts around the world. The cardiac exclusion criteria
are based on the opinions of a smaller number of experts
and should be considered interim recommendations until
a larger number of cardiologists are surveyed.
Our suggestion is that patients being considered for
transplant should be assessed by a rheumatologist with
specific expertise in the care of SSc. These physicians will
also record patient-related data in the Canadian Scleroderma
Research Group database and thus facilitate research in
the outcomes of transplant. A list of these physicians is also
included via the CSRG link (canadiansclerodermaresearchgroup.org/stem-cell-transplantation-criteria).
Currently, not all transplant centers in Canada are performing
these transplants. The three major sites are listed
but it may be possible that other sites closer to the homes
of the patients may also have the capability of doing the
transplant. The decision to perform a transplant at an unlisted
site should be made after a consultation between a
rheumatologist with expertise in SSc and the transplant
hematologist.
Murray Baron, MD, FRCP(C)
Chief, Division of Rheumatology, Jewish General Hospital
Director, Canadian Scleroderma Research Group
Professor of Medicine, McGill University
Montreal, Quebec
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