The following information has been provided by Alan M. Miller, Ph.D., M.D., Director, Bone Marrow Transplantation, Tulane University Medical Center, 1430 Tulane Avenue SL34, New Orleans, LA 70112.

      Transplantation of bone marrow cells and, more recently, stem cells collected from the blood have been used as part of the treatment for leukemias and other cancers for the past twenty years. Cells used in transplantation can be donated by others (allogeneic) or collected from the patients them-selves (autologous). One autoimmune disease, aplastic anemia, is routinely cured with allogeneic transplantation. There are several case reports of patients, who received marrow transplants for leukemia and also had autoimmune diseases, who achieved remissions from both diseases.

      An article in the May 19 Newsweek (page 60) discusses the possibility of using autologous stem cells,that have been separated from immune cells, for transplantation in patients with autoimmune diseases. The article presents the case of a young woman with multiple sclerosis (MS), with preliminary results being very encouraging. A few centers in the United States have now begun performing these treatments on an investigational basis.

      Bone marrow or stem cell transplantation should not be entered into casually. In order for the treatment to be suc-cessful, the patient must receive high doses of immunosuppressive chemotherapy and/or radiation therapy to eliminate the immune cells. The patient then receives a transplant of autolo-gous stem cells which have been purged of most immune cells. Several weeks of hospitalization and significant toxicities result, and experience with cancer tells us that up to 5 percent of patients may die from treatment-related complications. It is also expensive treatment, with costs estimated from $75,000 to over $125,000. The MS Society has cautioned that this type of treatment is "nei-ther a casual treatment approach nor it is appropri-ate even as an experimental treatment for the vast majority of people with MS."

      As with all new treatments, time and experience will be needed to determine its appropriate role in the overall treatment of autoimmune diseases.

      NOTE: The American Autoimmune Related Diseases Association also cautions that this treatment is not approved even as an experimental treatment for autoimmune diseases and should be considered only in life-threatening autoimmune diseases that have failed to respond to all other treatments.