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In Reply Dr Burt and colleagues emphasize the importance of extensive cardiopulmonary screening before undertaking autologous hematopoietic stem cell transplantation in patients with severe systemic sclerosis. When the ASTIS trial was launched in 2001, phase 1/2 data indicated that patients with systemic sclerosis and a mean pulmonary arterial pressure greater than 50 mm Hg measured by right heart catheterization had an unacceptable risk of treatment-related mortality1 and were therefore excluded from the ASTIS trial.
van Laar JM, Farge D, Tyndall A. Cardiac Assessment Before Stem Cell Transplantation for Systemic Sclerosis—Reply. JAMA. 2014;312(17):1803-1804. doi:10.1001/jama.2014.12572