Farber disease: clinical presentation, pathogenesis and a new approach to treatment.
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Farber disease: clinical presentation, pathogenesis and a new approach to treatment. / Ehlert, Karoline; Frosch, Michael; Fehse, Natalja; Zander, Axel R.; Roth, Johannes; Vormoor, Josef.
In: PEDIATR RHEUMATOL, Vol. 5, 2007, p. 15.Research output: SCORING: Contribution to journal › SCORING: Journal article › Research › peer-review
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T1 - Farber disease: clinical presentation, pathogenesis and a new approach to treatment.
AU - Ehlert, Karoline
AU - Frosch, Michael
AU - Fehse, Natalja
AU - Zander, Axel R.
AU - Roth, Johannes
AU - Vormoor, Josef
PY - 2007
Y1 - 2007
N2 - BACKGROUND: Farber Disease is an autosomal-recessively inherited, lysosomal storage disorder caused by acid ceramidase deficiency and associated with distinct clinical phenotypes. Children with significant neurological involvement usually die early in infancy, whereas patients without or only mild neurological findings suffer from progressive joint deformation and contractures, subcutaneous nodules, inflammatory, periarticular granulomas, a hoarse voice and finally respiratory insufficiency caused by granuloma formation in the respiratory tract and interstitial pneumonitis leading to death in the third or fourth decade of live. As the inflammatory component of this disorder is caused by some kind of leukocyte dysregulation, allogeneic hematopoietic stem cell transplantation can restore a healthy immune system and thus may provide a curative option in Farber Disease patients without neurological involvement. Previous stem cell transplantations in two children with severe neurological involvement had resulted in a disappointing outcome, as both patients died of progressive deterioration of their neurological status. As a consequence, stem cell transplantation does not appear to be able to abolish or even reduce the neurotoxic effects of the abundant ceramide storage in the brain. METHODS: After myeloablative, busulfan-based preparative regimens, four Farber Disease patients without neurological involvement received an allogeneic hematopoietic stem cell transplantation from related and unrelated donors. Stem cell source was BM in three patients and PBSC in one patient; GvHD-prophylaxis consisted of CsA and short course MTX. RESULTS AND DISCUSSION: In all patients, HSCT resulted in almost complete resolution of granulomas and joint contractures, considerable improvement of mobility and joint motility without relevant therapy-related morbidities. All patients are alive and well at this point with stabile donor cell chimerism and without evidence of chronic GvHD or other late sequelae of stem cell transplantation. CONCLUSION: Allogeneic hematopoietic stem cell transplantation provides a promising approach for Farber Disease patients without neurological involvement.
AB - BACKGROUND: Farber Disease is an autosomal-recessively inherited, lysosomal storage disorder caused by acid ceramidase deficiency and associated with distinct clinical phenotypes. Children with significant neurological involvement usually die early in infancy, whereas patients without or only mild neurological findings suffer from progressive joint deformation and contractures, subcutaneous nodules, inflammatory, periarticular granulomas, a hoarse voice and finally respiratory insufficiency caused by granuloma formation in the respiratory tract and interstitial pneumonitis leading to death in the third or fourth decade of live. As the inflammatory component of this disorder is caused by some kind of leukocyte dysregulation, allogeneic hematopoietic stem cell transplantation can restore a healthy immune system and thus may provide a curative option in Farber Disease patients without neurological involvement. Previous stem cell transplantations in two children with severe neurological involvement had resulted in a disappointing outcome, as both patients died of progressive deterioration of their neurological status. As a consequence, stem cell transplantation does not appear to be able to abolish or even reduce the neurotoxic effects of the abundant ceramide storage in the brain. METHODS: After myeloablative, busulfan-based preparative regimens, four Farber Disease patients without neurological involvement received an allogeneic hematopoietic stem cell transplantation from related and unrelated donors. Stem cell source was BM in three patients and PBSC in one patient; GvHD-prophylaxis consisted of CsA and short course MTX. RESULTS AND DISCUSSION: In all patients, HSCT resulted in almost complete resolution of granulomas and joint contractures, considerable improvement of mobility and joint motility without relevant therapy-related morbidities. All patients are alive and well at this point with stabile donor cell chimerism and without evidence of chronic GvHD or other late sequelae of stem cell transplantation. CONCLUSION: Allogeneic hematopoietic stem cell transplantation provides a promising approach for Farber Disease patients without neurological involvement.
U2 - 10.1186/1546-0096-5-15
DO - 10.1186/1546-0096-5-15
M3 - SCORING: Zeitschriftenaufsatz
VL - 5
SP - 15
JO - PEDIATR RHEUMATOL
JF - PEDIATR RHEUMATOL
SN - 1546-0096
ER -