A179 AUTOLOGOUS BONE MARROW TRANSPLANT FOR REFRACTORY CROHN’S DISEASE: A CASE SERIES

Abstract

BackgroundCrohn’s disease (CD), a form of inflammatory bowel disease (IBD) is a chronic, immune mediated condition characterized by gastrointestinal inflammation. Approximately 25% of CD patients have pharmacologically refractory disease, in which stem cell therapy has been shown to play a role.AimsA case series was performed to analyze the efficacy of autologous bone marrow transplantation (ABMT) for refractory CD in British Columbia(B.C).MethodsA chart review was conducted on patients who had undergone ABMT for treatment refractory CD between 2001 to 2021 in B.C. Demographic, clinical, laboratory and endoscopic data was collected.ResultsCase details are summarized in Table 1. 3 patients(2 female and one male) were included. All patients failed conventional therapies prior to ABMT. 2 patients underwent surgical intervention (colectomy with ileostomy) prior to ABMT. Average time from diagnosis to ABMT was 8.83 + 6.6 years. All 3 patients received standard myeloablative therapy. There were no intestinal complications post ABMT. 6 months post-ABMT transplant, all 3 patients showed significant improvement, with CDAI scores <150. Endoscopic assessment post-ABMT revealed endoscopic remission in 2 of the 3 patients. 2 of the 3 patients were in clinical remission at 12 months follow up. 1 patient relapsed and required further immunosuppressive therapy. This patient was trialed on thalidomide at 15 months post-ABMT and ultimately passed away 18 months post-ABMT from an unrelated cause. 10 years post-transplant, the remaining 2 patients remain in clinical and endoscopic remission with CDAI scores <150.ConclusionsDespite medical and surgical therapeutic advances, a subset of CD patients develop refractive disease associated with significant morbidity and mortality. In this population, there is increasing evidence in support of stem cell therapy as a treatment modality, with acute mortality less than 5% for patients with malignancy driven primarily by infectious complications and treatment-related toxicity. Clinical trials are currently underway to evaluate ABMT in CD. This case series presents the only Canadian data to date on the use of ABMT for refractory CDs and their subsequent follow up.Summary of Patient Demographics, Clinical and Disease CharacteristicsCase 1Case 2Case 3SexMFFYear of Birth198319922000Year of Diagnosis199420052011Extraintestinal Manifestations of Crohn’s DiseaseOsteoporosisArthritisArthritisPrevious Treatments5-ASA, Corticosteroids, Azathioprine, Infliximab, Adalimumab5-ASA, Corticosteroids, Methotrexate, Infliximab, AdalimumabCorticosteroids, Azathioprine, Infliximab, Visiluzumab, Adalimumab, ThalidomideSurgical HistoryTotal Colectomy and Small Bowel ResectionNoneTotal ColectomyAge at Stem Cell Therapy301814Recurrence of IBD after stem cell therapyNoNoYesFollow up after stem cell therapy8 years10 years1.5 yearsEndoscopic control after transplantation2014: EGD showed pristine mucosa, SES score of 02019: Lower GI endoscopy revealed completely normal colonic mucosa with SES score of 0.2015: Upper GI endoscopy showed mild patchy erythema involving gastric body. No ulcers. Patchy duodenitis with small aphthous ulcers. 2015: Lower GI endoscopy demonstrated patchy erosions in rectum, normal ileum and colonic mucosa.Funding AgenciesNone