Safety and efficacy of autologous haematopoietic stem-cell transplantation with low-dose cyclophosphamide mobilisation and reduced intensity conditioning versus standard of care in refractory Crohn's disease (ASTIClite): an open-label, multicentre, randomised controlled trial
A large number of patients living with Inflammatory Bowel Disease (IBD), including Crohn’s Disease (CD), show persistent disease activity and bowel damage despite medical or surgical therapy [1]. Haematopoietic stem-cell transplantation (HSCT) is a procedure able to “reset” the immune system by replacing autoreactive lymphocytes. A total of 232 patients (data from case series, observational studies and one clinical trial) had previously undergone HSCT for CD. Although there were promising clinical results, there were also some significant associated risks, including life-threatening side effects and mortality [2]. In a previous randomised controlled trial, called ASTIC, HSCT did not demonstrate superiority over standard therapy when an extremely high bar was set for the primary endpoint, i.e. induction of sustained disease remission in CD (defined as medication-free clinical remission for 3 months without any evidence of disease activity at endoscopy or imaging). Apart from the lack of efficacy demonstrated for the primary endpoint, the HSCT arm was also hampered by a significant burden of side effects [3].
Ulcerative Colitis (UC) is characterised by episodes of recurrent inflammation affecting the colonic mucosa. Accurate assessment of disease activity and prediction of clinical outcomes are crucial for effective management. Traditionally, histological examination has been the gold standard for evaluating mucosal inflammation, but it is time-consuming and subject to inter-observer variability. Recent advances in artificial intelligence (AI) may offer a potential solution. Iacucci and colleagues explored the application of machine learning in diagnosing histological remission and predicting clinical outcomes in UC patients.
Patients with colonic inflammatory bowel disease (IBD) face an elevated risk of colorectal cancer (CRC) compared to the general population.[1, 2] Colonoscopic surveillance has been shown to be associated with a reduction in CRC and CRC-related mortality in these patients.[3] Current guidelines recommend initiating surveillance 8-10 years after disease onset, with follow-ups every 1-5 years based on individual risk factors.[4–6] These factors include disease duration, severity, associated primary sclerosing cholangitis (PSC), family history of CRC, and other risks. The risk factors for CRC in IBD patients are dynamic, comprising both modifiable (inflammation, dysplasia detection, disease extent) and non-modifiable (age, family history, PSC) elements that change over time and with treatment, exerting varying influences, including protective effects, on the risk of developing CRC.[7]
