Brief communication IImmunoablative therapy with autologous stem cell transplantation in the treatment of poor risk multiple sclerosis
Section snippets
Patients and methods
The treatment protocol was approved by the institutional ethical committee. All patients were in nonresponsive secondary progressive phase of MS with advanced scores on the Kurtzke scale and rapid progression.9 Patients had typical findings on their brain NMRs, and characteristic oligoclonal bands in their CSF. Patients were classified using the Kurtzke and Scripps scales and filmed on video.10 Previous treatment included a combination of corticosteroids with other immunosuppressive and
Toxicity of intensive immunosuppressive therapy
No life-threatening event was noted during transplantation. Leukopoiesis recovered (WBC > 1.0 × 109/L) a median of 9 days posttransplant (range, 8 to 10 days). Thrombopoiesis was renewed (PLT > 20 × 109/L with no need for platelet concentrates) a median of 11 days posttransplant (range, 9 to 14 days). Each patient had fever during neutropenia. In three patients, an agent was isolated from blood cultures. A gram-positive bacteria was involved in two cases, and both gram-negative and
Discussion
A correct indication is the key step in immunoablative therapy. In the case of MS, this method is as yet confined to patients with a significant degree of disability, with rapid progression of their neurologic deficit, and with no effect of any other treatment. For patients in the terminal phase of MS, where no great improvement in quality of life can be expected, this method is not indicated.
The question whether only profound long-lasting immunosuppression is responsible for the effect of the
Acknowledgements
The authors acknowledge Dr L. Rosa, the head of the Department of Clinical Haematology, University Hospital Královské Vinohrady; the nursing staff of the BMT unit, especially M. Patorkova; and the staff of the Apheresis Unit at the Blood Transfusion Department, especially Dr M. Greplova, Dr D Kraftova, and Dr J Kracikova for their substantial support.
References (15)
- et al.
Blood
(1998) - et al.
Blood
(1998) - et al.
Bone Marrow Transplant
(1997) Haematologica
(1998)Clin Immunol Immunopathol
(1998)- et al.
Bone Marrow Transplant
(1997)
Cited by (31)
A review of hematopoietic stem cell transplantation for autoimmune diseases: multiple sclerosis, systemic sclerosis and Crohn's disease. Position paper of the Brazilian Society of Bone Marrow Transplantation
2021, Hematology, Transfusion and Cell TherapyCitation Excerpt :Since the mid-1990s, with the first studies on animal models with subsequent clinical application, autologous transplantation (AHSCT) has been an important tool in inducing an “immunotolerant” immune reconstitution.2,3 Thousands of transplants for treating MS have been performed worldwide, with more than 700 evaluated in studies.6,28–46 Some studies showed progression-free survival of more than five years,39,43 with superior neurological improvement in patients with relapsing-remission type and in those with inflammatory activity observed on magnetic resonance imaging.43,47,48
Haematopoietic stem cell transplantation in autoimmune diseases: From basic science to clinical practice
2016, Current Research in Translational MedicineTherapy of MS
2010, Clinical Neurology and NeurosurgeryCitation Excerpt :Since the earliest studies, over 400 patients have been transplanted worldwide [152]. Neurological outcome in AHSCT has been assessed in small phase I/II studies done by single-centres [145,153–164] and by collaborative efforts of various teams from several countries [151,165–169]. Transplant-related mortality has dropped from 6% in the first reported cohorts to approximately 1% [152].
Autologous and allogeneic hematopoietic stem cell transplantation for Multiple Sclerosis: Perspective on mechanisms of action
2008, Journal of NeuroimmunologyCitation Excerpt :To date, more than 25 clinical studies, on a total of more than 200 MS patients treated with autologous HSCT, have been performed. Most of these reports describe rather small groups of patients with relatively short follow-up times, and variability exists with regard to the source of HSC (Table 1) (Burt et al., 1998b,c, 2003; Oyama et al., 2002; Fassas et al., 1997, 2000; Openshaw et al., 2000; Kozak et al., 2000, 2001; Saiz et al., 2001, 2004; Blanco et al., 2005; Carreras et al., 2003; Mancardi et al., 2001; Inglese et al., 2004; Saccardi et al., 2005; Nash et al., 2003a,b; Healey et al., 2004; Samijn et al., 2006; Ni et al., 2006; Xu et al., 2006; Su et al., 2006). Fassas et al. (2002) published a comprehensive review of the clinical experience with autologous HSCT in MS. The authors give an overview of patients registered in the European Blood and Marrow Transplantation (EBMT) database, some of which had been previously described in smaller single-centre studies (Table 1).
Bone marrow transplantation: Does it stop MS progression?
2007, Journal of the Neurological SciencesAllogeneic Bone Marrow Transplantation in Models of Experimental Autoimmune Encephalomyelitis: Evidence for a Graft-versus-Autoimmunity Effect
2007, Biology of Blood and Marrow TransplantationCitation Excerpt :Nevertheless, these therapeutic approaches are only partially effective and fail to achieve satisfactory disease control in a number of patients, probably because of incomplete suppression and persistence of myelin-reactive T cells. The assumptions that ablation of the immune system would include destruction of the autoreactive repertoire, and that reconstitution with hematopoietic stem cells would lead to “resetting” of the immune compartment and to restoration of unresponsiveness to self-antigens, have led investigators to study the effects of autologous hematopoietic stem cell transplantation (HSCT) in MS [6-12]. In their retrospective multicenter study, Fassas et al. [6] reviewed 85 progressive MS patients, treated with various protocols of autologous HSCT and followed for a mean time of 16 months.