Results Our data on autologous T cell-depleted HSCT in 6 children with juvenile idiopathic arthritis have been recently published2: four are long-term survivors, three in complete drug-free remission, one relapsed and two died. The authors compare these with the results of allogeneic HSCT in seven children with well-defined, severe and treatment-resistant autoimmune and autoinflammatory diseases: systemic lupus erythematosus (1), immunodysregulation, polyendocrinopathy, enteropathy, X-linked syndrome (3), autoimmune lymphoproliferative syndrome (2), complex periodic fever syndrome due to both mevalonic kinase and TNF-receptor gene mutations (1). Half received HSC from an HLA-matched sibling and half from an unrelated donor; 5/7 received modified myeloablative or reduced intensity conditioning. One child died; 6 achieved remission from their underlying disease: four are cured with 2–6 year follow-up, one with slipping donor chimerism requires further treatment and one is still <1 year post-HSCT. Acute GVHD was frequent but resolved with therapy.

Conclusion The benefit–risk ratio for allogeneic HSCT using contemporary protocols in specialised centres may have surpassed T cell-depleted autologous HSCT for severe autoimmune/rheumatic disease.