Трансплантация аутологичных гемопоэтических стволовых клеток c целью лечения активного анкилозирующего спондилита (клиническое наблюдение)

Abstract

Nowadays, patients with ankylosing spondylitis (AS) receive drugs for an indefinite period of time, which determines the need to search for new types of treatment that can induce medium- and long-term drug-free remission. Some authors consider the possibility of autologous hematopoietic stem cell transplantation (aHSCT) in combination with high-dose chemotherapy as such methods of treatment. The evidence base on the efficacy and safety of aHSCT in AS is represented by single cases, one of which we are currently presenting. The article presents the results of a seven-year clinical follow-up concerning a male patient with severe AS who underwent aHSCT, which led to the achievement of short-term remission with subsequent disease exacerbation. Due to the high activity of AS and zero treatment result, it was decided to initiate treatment with the interleukin 17A (IL-17A) inhibitor, secukinumab. At the time of writing, the patient has been receiving secukinumab at a dose of 300 mg per month for 3 years. During the first year of treatment, there was a significant positive clinical and laboratory tendency in the form of a pain syndrome reduction, normalization of ESR and CRP levels, a decrease in the BASDAI index to 3.2 points, and the ASDAS index to 1.8 points. The authors conclude that aHSCT in combination with high-dose chemotherapy and subsequent administration of cyclosporine A in the presented case did not lead to persistent remission of AS, and the risk–benefit ratio for the patient is shifted towards risk. At the same time, treatment with IL-17A inhibitor in a standard dosage allowed to control the disease activity with a high safety profile for 3 years. KEYWORDS: ankylosing spondylitis, Bekhterev’s disease, radiographic axial spondyloarthritis, autologous hematopoietic stem cell transplantation, TNF-alpha inhibitors, IL-17A inhibitor, remission. FOR CITATION: Benevolenskaya S.S., Maslyansky A.L., Chudinov A.L. et al. Autologous hematopoietic stem cell transplantation for the treatment of active ankylosing spondylitis (clinical case). Russian Medical Inquiry. 2022;6(8):486–490 (in Russ.). DOI: 10.32364/2587- 6821-2022-6-8-486-490.