The successful treatment of refractory Crohn's disease by high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation: a clinical case

Despite the available novel drug treatments for inflammatory bowel diseases, the number of patients with treatment resistance has been growing. These patients might need more aggressive treatment strategies, as the lack of control over the persistent active inflammation results in the progression of Crohn's disease and development of complications. By now, two randomized controlled studies of high-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation (HDIT-AHSCT) for the treatment of refractory Crohn's disease (ASTIC and ASTIC-lite) have been completed: their results are quite equivocal. The paper presents the description of a clinical case illustrating the possibility of HDIT-AHSCT as an alternative strategy to achieve remission in a patient with refractory Crohn's disease. This was a young patient with a difficult-to-treat inflammatory Crohn's disease (terminal ileitis and colitis with perianal lesion – A2L3B1p) with high disease activity (frequent loose stools, severe fatigue, abdominal pain, weight loss; C-reactive protein 13 mg/l, erythrocyte sedimentation rate 40 mm/h, fecal calprotectin 1500 mcg/g, SES-CD 8 points). He underwent an HDIT-AHSCT procedure resulting in clinical, laboratory and endoscopic remission at 24 weeks. Up to 24 months, he did not require any resumption of the immunosuppressive and biological therapy. At present, the patient's follow up and monitoring is ongoing. Further accumulation of clinical data is needed for the evaluation of the efficacy and safety of HDIT-AHSCT, profiling of the patient candidates for the use of the procedure, choice of optimal conditioning regimens, time and algorithms of anti-relapse therapy.