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Pros and cons of hematopoietic stem cell transplant for autoimmune disease

Approximately 300 cases of various autoimmune diseases have been transplanted worldwide. Diversity in clinical manifestations and variability in disease course are important factors in considering a patient for stem cell transplantation. The pros of considering hematopoietic stem cell transplant (HSCT) for autoimmune disorders are: 1) high disease-related morbidity and mortality; 2) ability to offer disease-remitting therapy, 3) as a model to understand disease pathogenesis, and 4) if successful, limiting the societal and individual costs of debilitating autoimmune disorders. Conversely, the cons of performing HSCT for autoimmune diseases are: 1) mortality from HSCT, 2) expectation bias inherent to phase I/II studies, 3) unknown long-term efficacy, and 4) cost of transplant.