Brief communication I
Immunoablative therapy with autologous stem cell transplantation in the treatment of poor risk multiple sclerosis

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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.

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    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.

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