Sustained Clinical Remission Following a Second Autologous Hematopoietic Stem Cell Transplantation for Refractory Crohn Disease.

Crohn disease is a debilitating inflammatory bowel disease lacking curative options for patients refractory to standard medical therapy. While autologous hematopoietic stem cell transplantation has demonstrated therapeutic potential in selected cases of refractory disease, there are no prior reports documenting its use in a repeat setting for this indication. A 48-year-old male patient with severe, refractory Crohn disease who failed comprehensive medical management, including multiple biologic agents is presented. Following a rapid clinical relapse six months after an initial non-myeloablative autologous hematopoietic stem cell transplantation, a second procedure was performed three years later using the same mobilization and conditioning regimen (cyclophosphamide and rabbit anti-thymocyte globulin), with the addition of one year of post-transplant cyclosporine to maintain sustained immunosuppression. At 30 months following the second autologous hematopoietic stem cell transplantation, the patient remains in sustained clinical and endoscopic remission off all immunosuppressive and biologic medications. This case documents the feasibility and favorable long-term outcome of a second non-myeloablative autologous hematopoietic stem cell transplantation, suggesting this approach may be a valid and effective salvage option for highly selected patients with severe, refractory Crohn disease.