Review
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World J Gastroenterol. Dec 14, 2014; 20(46): 17368-17375
Published online Dec 14, 2014. doi: 10.3748/wjg.v20.i46.17368
Hematopoietic stem cell transplantation for non-malignant gastrointestinal diseases
Abdulbaqi Al-toma, Petula Nijeboer, Gerd Bouma, Otto Visser, Chris JJ Mulder
Abdulbaqi Al-toma, Department of Internal Medicine and Gastroenterology, 3430 EM Nieuwegein, The Netherlands
Petula Nijeboer, Gerd Bouma, Chris JJ Mulder, Department of Gastroenterology, VU University Medical Centre, 1005 MB Amsterdam, The Netherlands
Otto Visser, Department of Hematology, VU University Medical Centre, 1005 MB Amsterdam, The Netherlands
Author contributions: Al-toma A and Nijeboer P have performed literature search and wrote the manuscript; Bouma G, Visser O and Mulder CJJ have critically revised the manuscript, provided scientific input and feedback.
Correspondence to: Abdulbaqi Al-toma, MD, PhD, Gastroenterologist, Department of internal medicine and gastroenterology, St. Antonius hospital, Koekoeslaan 1, 3430 EM Nieuwegein, The Netherlands. a.altoma@antoniusziekenhuis.nl
Telephone: +31-30-6099111 Fax: +31-30-6056357
Received: March 7, 2014
Revised: April 30, 2014
Accepted: September 29, 2014
Published online: December 14, 2014
Processing time: 286 Days and 0.1 Hours
Abstract

Both, autologous and allogeneic hematopoietic stem cell transplantation (HSCT) can be used to cure or ameliorate a variety of malignant and non-malignant diseases. The rationale behind this strategy is based on the concept of immunoablation using high-dose chemotherapy, with subsequent regeneration of naive T-lymphocytes derived from reinfused hematopoietic progenitor cells. In addition, the use of HSCT allows for the administration of high-dose chemotherapy (whether or not combined with immunomodulating agents such as antithymocyte globulin) resulting in a prompt remission in therapy-refractory patients. This review gives an update of the major areas of successful uses of HSCT in non-malignant gastrointestinal disorders. A Medline search has been conducted and all relevant published data were analyzed. HSCT has been proved successful in treating refractory Crohn’s disease (CD). Patients with refractory celiac disease type II and a high risk of developing enteropathy associated T-cell lymphoma have shown promising improvement. Data concerning HSCT and mesenchymal SCT in end-stage chronic liver diseases are encouraging. In refractory autoimmune gastrointestinal diseases high-dose chemotherapy followed by HSCT seems feasible and safe and might result in long-term improvement of disease activity. Mesenchymal SCT for a selected group of CD is promising and may represent a significant therapeutic alternative in treating fistulas in CD.

Keywords: Hematopoietic stem cell transplantation; Mesenchymal stem cells; Non-malignant gastrointestinal diseases; Celiac disease; Refractory celiac disease; Lymphoma; Crohn’s; Ulcerative colitis; Cirrhosis

Core tip: Hematopoietic stem cell transplantation (HSCT) can be used to treat malignant and non-malignant diseases. This therapeutic modality is based on using immunoablation followed by reinfusion of hematopoietic progenitor cells to regenerate naive T-lymphocytes. HSCT and mesenchymal SCT have been proved successful in treating refractory inflammatory conditions such as Crohn’s disease and refractory celiac disease type II. The ultimate target of aggressively treating this type of celiac disease is to prevent development of lymphoma. Data in end-stage liver diseases are also encouraging.