Risk taking in patients with rheumatoid arthritis: are the risks of haemopoietic stem cell transplantation acceptable?

被引:20
作者
Snowden, JA
Nivison-Smith, I
Biggs, JC
Brooks, PM
机构
[1] St Vincents Hosp, Dept Haematol, Sydney, NSW 2010, Australia
[2] St Vincents Hosp, Med Professorial Unit, Sydney, NSW 2010, Australia
关键词
rheumatoid arthritis; bone marrow transplantation; stem cell transplantation; autoimmune diseases;
D O I
10.1093/rheumatology/38.4.321
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objectives. Autologous haemopoietic stem cell transplantation (HSCT), which carries defined risks of early treatment-related mortality (TRM), has recently been proposed as an experimental therapy for severe rheumatoid arthritis (RA). The aim of this study was to establish whether the risks of this approach are acceptable to patients with RA and whether risk taking related to disease-associated or personal/social parameters. Methods. A standard gamble questionnaire was used to determine the acceptable risk of mortality for a potentially curative procedure in patients with RA aged <70 yr. Additional data collected included age, sex, duration of RA, number of second-line agents, domestic and workforce information, and self-assessed disability. Results. The 53 patients (age range 24-69 yr, 39 female, 14 male, disease duration 2-43 yr) interviewed were prepared to accept a broad range of treatment-related mortality in order to be returned to normality off all drugs (median 5%, range 0-50%). Risk taking was significantly related to degree of disability measured by the disability section of the Health Assessment Questionnaire (HAQ; P = 0.001)and negatively related to age (P = 0.04), although only HAQ score maintained significance on multivariate analysis. Using linear regression, we were able to determine that current TRM of autologous HSCT in Australia (3.3%) would be acceptable to patients with HAQ scores of >0.44 (84% of our sample), but allogeneic HSCT (with a TRM of 13.1%) would be acceptable only to severely disabled patients with HAQ scores of >2.45 (4% of our sample), assuming the procedure to be curative. Conclusion. Along with previous studies, these results suggest that, if long-term efficacy can be proven, then the risks of autografting may be acceptable to most patients with RA, particularly those with significant disability.
引用
收藏
页码:321 / 324
页数:4
相关论文
共 18 条
[1]   Haemopoietic stem cell transplantation in Australia, 1992-95: a report from the Australian Bone Marrow Transplant Recipient Registry [J].
Atkinson, K ;
NivisonSmith, I ;
Hawkins, T .
AUSTRALIAN AND NEW ZEALAND JOURNAL OF MEDICINE, 1997, 27 (04) :408-419
[2]  
Bagge E, 1997, BRIT J RHEUMATOL, V36, P470
[3]  
CHAO NJ, 1992, BLOOD, V80, P825
[4]   Remission and immune reconstitution after T-cell-depleted stem-cell transplantation for rheumatoid arthritis [J].
Durez, P ;
Toungouz, M ;
Schandené, L ;
Lambermont, M ;
Goldman, M .
LANCET, 1998, 352 (9131) :881-881
[5]   MEASUREMENT OF PATIENT OUTCOME IN ARTHRITIS [J].
FRIES, JF ;
SPITZ, P ;
KRAINES, RG ;
HOLMAN, HR .
ARTHRITIS AND RHEUMATISM, 1980, 23 (02) :137-145
[6]   Autologous bone-marrow transplantation for rheumatoid arthritis [J].
Joske, DJL .
LANCET, 1997, 350 (9074) :337-338
[7]   WORLDWIDE TRENDS IN THE SOCIOECONOMIC IMPACT AND LONG-TERM PROGNOSIS OF RHEUMATOID-ARTHRITIS [J].
MARKENSON, JA .
SEMINARS IN ARTHRITIS AND RHEUMATISM, 1991, 21 (02) :4-12
[8]   WILLINGNESS TO ACCEPT RISK IN THE TREATMENT OF RHEUMATIC DISEASE [J].
OBRIEN, BJ ;
ELSWOOD, J ;
CALIN, A .
JOURNAL OF EPIDEMIOLOGY AND COMMUNITY HEALTH, 1990, 44 (03) :249-252
[9]   DECISION-ANALYSIS [J].
PAUKER, SG ;
KASSIRER, JP .
NEW ENGLAND JOURNAL OF MEDICINE, 1987, 316 (05) :250-258
[10]   LONG-TERM EFFECTS OF TREATING RHEUMATOID-ARTHRITIS [J].
RASKER, JJ ;
COSH, JA .
BAILLIERES CLINICAL RHEUMATOLOGY, 1992, 6 (01) :141-160