Treatment of chronic spinal cord injured patients with autologous bone marrow-derived hematopoietic stem cell transplantation: 1-year follow-up

Purpose: Traumatic spinal cord injury (SCI) is a severe neurological disease which causes sensory loss, motor paralysis and autonomic difficulties which is usually treated with physiotherapy. Complete spinal cord injury with ASIA Grade A patients remains untreated and neglected in our country since long back. Here we describe an effective strategy for the treatment of complete spinal cord injury by autologous bone marrow derived stem cell. Material and Method: The study was conducted in the Neurosurgery department, Dhaka Medical College Hospital, Dhaka, Bangladesh from January, 2016 to January 2019. Total 22 Patients with spinal cord injury (ASIA Grade-A) were included in this study. Total 60 ml of autologous bone marrow was aspirated and processed to prepare 6-7 ml of bone marrow aspirate concentrate (BMAC) which was transplanted at the site of cord injury. Bony alignment was done by decompression and stabilization. Post-surgical physiotherapy and regular follow up was given. Result: Surgical outcome was assessed by ASIA Grading. Among 22 patients, 10 patients (45.45%) improved by one grade, 7 patients (31.82%) improved by two grade, 2 patients (9.09%) improved by three grade, 3 patients (13.64%) did not show any improvement of any grade as because their follow-up period was less than 6 months. 19 patients (86.36%) noticed sensory, 16 patients (72.72%) noticed bladder improvement and 19 patients (86.36%) noticed bowel improvement to some extent. Conclusion: Stem cell therapy is safe and effective. Steady and focused progress in stem cell research will open the door for many disable patients in the country like Bangladesh. Bang. J Neurosurgery 2019; 9(1): 3-10

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NeuroRegen Scaffolds Combined with Autologous Bone Marrow Mononuclear Cells for the Repair of Acute Complete Spinal Cord Injury: A 3-Year Clinical Study

Cell Transplantation ◽

10.1177/0963689720950637 ◽

2020 ◽

Vol 29 ◽

pp. 096368972095063

Author(s):

Wugui Chen ◽

Ying Zhang ◽

Sizhen Yang ◽

Jing Sun ◽

Hao Qiu ◽

...

Keyword(s):

Spinal Cord ◽

Bone Marrow ◽

Spinal Cord Injury ◽

Stem Cell ◽

Mononuclear Cells ◽

Autologous Bone Marrow ◽

Bone Marrow Mononuclear Cells ◽

Cord Injury ◽

Autologous Bone

Spinal cord injury (SCI) remains among the most challenging pathologies worldwide and has limited therapeutic possibilities and a very bleak prognosis. Biomaterials and stem cell transplantation are promising treatments for functional recovery in SCI. Seven patients with acute complete SCI diagnosed by a combination of methods were included in the study, and different lengths (2.0–6.0 cm) of necrotic spinal cord tissue were surgically cleaned under intraoperative neurophysiological monitoring. Subsequently, NeuroRegen scaffolds loaded with autologous bone marrow mononuclear cells (BMMCs) were implanted into the cleaned site. All patients participated in 6 months of rehabilitation and at least 3 years of clinical follow-up. No adverse symptoms associated with stem cell or functional scaffold implantation were observed during the 3-year follow-up period. Additionally, partial shallow sensory and autonomic nervous functional improvements were observed in some patients, but no motor function recovery was observed. Magnetic resonance imaging suggested that NeuroRegen scaffold implantation supported injured spinal cord continuity after treatment. These findings indicate that implantation of NeuroRegen scaffolds combined with stem cells may serve as a safe and promising clinical treatment for patients with acute complete SCI. However, determining the therapeutic effects and exact application methods still requires further study.

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Autologous bone marrow derived stem cell therapy in traumatic spinal cord injury: A case report and review of literature

Indian Journal of Neurotrauma ◽

10.1016/j.ijnt.2014.11.009 ◽

2014 ◽

Vol 11 (2) ◽

pp. 150-153

Author(s):

Pradipta Tripathy ◽

Chidananda Dash ◽

Aurobind Rath ◽

S. Chakraborty ◽

Jagannath Sahoo ◽

...

Keyword(s):

Spinal Cord ◽

Bone Marrow ◽

Spinal Cord Injury ◽

Stem Cell ◽

Case Report ◽

Autologous Bone Marrow ◽

Traumatic Spinal Cord Injury ◽

Review Of Literature ◽

Cord Injury ◽

Autologous Bone

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Autologous Bone Marrow-Derived Stem Cell Therapy in Patients with Severe Peripheral Arterial Disorders: A Pilot Study.

Blood ◽

10.1182/blood.v110.11.2877.2877 ◽

2007 ◽

Vol 110 (11) ◽

pp. 2877-2877

Author(s):

Zoltan Boda ◽

Miklos Udvardy ◽

Katalin Razso ◽

Mariann Szarvas ◽

Katalin Farkas ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Autologous Bone Marrow ◽

Clinical Results ◽

Walking Distance ◽

Rest Pain ◽

Cd34 Cells ◽

Autologous Bone ◽

Peripheral Arterial

Abstract Introduction. Amputation is the only current option for relief of rest pain or gangrene in patients with severe peripheral arterial disease (SPAD). Up to now, no effective blood-flow enhancement therapies are available. Autologous bone marrow-derived stem cell transplantation (ABMSCT) is an arising therapy modality with an option of building new blood vessels through endothelial stem and/or progenitor cells. Methods. Five patients with SPAD (4 with Buerger’s disease and 1 with arteriosclerosis obliterans) were treated by ABMSCT. CD34+/CD133+ cell counts were determined in aspirated bone marrow, CD34+ cells were isolated by magnetic separation and collected into a 10 ml sample. The stem cell suspension was administered by local intramuscular injections (0.5–1.0 ml injections in the musculus gastrocnemius). The follow-up (before; 1−, 3− and 6 months after ABMSCT) based on clinical (rest pain, walking distance without pain, changes of non-healing ulcers, ABI) and laboratory (DS-angiography, Color- and Laser-Doppler scan, TcPO2 measurement and endothel function test) parameters was documented and analyzed. Our goal was to treat the worse limb of all the 5 patients. Results. Therapeutic benefit was shown by complete regression of rest pain in all 5 patients, and by the significant increase of pain-free walking distance (36 m vs. 440 m). Six months after ABMSCT the ischemic ulcers disappeared in 2 patients, and in another 2 patients the large and deep ulcers became smaller and thinner (from 8 cm2 to 2.6 cm2 in one case, and from 30 cm2 to 8 cm2 in another case), and in 1 case no change was realized, where osteomyelitis of the affected toe was diagnosed. The average of ABI improved significantly on the treated lower limb (before: 0.41, 3 and 6 months after: 0.64/0.82). ABI values of the contra-lateral legs did not change. The clinical improvement started 1 months after ABMSCT, it became more prominent after 3 months, and the best clinical results were observed after 6 months of transplantation. Confirmed by post-trial observations obtained at 9 months the clinical improvement was evaluated as stable and long lasting. Using angiography we realized improvement in 3 cases, but only in 1 case using Color-Doppler scan. Before and 6/20 weeks after transplantation the TcPO2 changed on the foot from 18.80/16.78/23.83 mmHg, and on the calf from 36.66/31.25/45.00 mmHg. The laboratory parameters did not show improvement after 1 month, however, after 3 and 6 months improved parameters were recorded. No severe complications, adverse events were detected during the 6 months follow-up period. Conclusions. ABMSCT with isolated CD34+ cells was proved to be safe, effective and resulted in significant and sustained improvement of clinical parameters and quality of life for patients with SPAD. Multicentric, controlled clinical trials are required to confirm these preliminary clinical results.

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Pregnancy after Allogeneic Hematopoietic Stem Cell Transplantation in Fanconi Anemia Patients: Multi-Institution Cases Report of Female Fertility Recovery

Blood ◽

10.1182/blood.v112.11.456.456 ◽

2008 ◽

Vol 112 (11) ◽

pp. 456-456

Author(s):

Samir Kanaan Nabhan ◽

Marco Bittencourt ◽

Michel Duval ◽

Manuel Abecasis ◽

Carlo Dufour ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cell Transplantation ◽

Fanconi Anemia ◽

Myeloablative Conditioning ◽

Hematopoietic Stem ◽

Fertility Recovery

Abstract Introduction. Fanconi anemia (FA) is a rare autosomal recessive syndrome characterized by chromosome instability. Main clinical features include progressive bone marrow failure, skeletal defects, increased susceptibility to malignancy and reduced fertility. Moreover, most recipients of allogeneic hematopoietic stem cell transplantation (HSCT) suffer from secondary infertility owing to gonadal damage from myeloablative conditioning. We report a rare clinical situation of FA patients pregnancy after allogeneic HSCT. Methods. Retrospective analysis of transplanted FA female patients from 1982 to 2008. Five centers participated in this study on behalf of Aplastic Anaemia Working Party-EBMT. Medical records were reviewed and data collected on a standard case report form including detailed information on diagnosis, transplant procedure, gynecological and obstetrics follow-up. Results. Among 387 transplanted FA patients we identified 202 females who performed a HSCT with a median age of 10,5 years. Five patients became pregnant after the procedure and one of them, twice. They all had their FA diagnosis confirmed by chromosomal breakage test and a bone marrow aspirate with severe hypoplasia/aplasia. Median age at transplantation was 12 years (range 5–17 years). All patients received myeloablative conditioning regimens (cyclophosphamide with or without thoraco-abdominal irradiation) before a bone marrow transplantation, 4 patients from HLA matched sibling donors and 1 from unrelated donor. During follow-up, 4 patients presented signs of ovarian failure (amenorrhea, low levels of FSH/LH and high levels of estradiol). Apart from 1 patient who spontaneously recovered regular menses, the other three received hormonal replacement therapy (HRT) for this purpose. Pregnancy occurred from 3,5 to 17 years after transplant. One patient had an early interruption with a caesarian section at 27 weeks because of an imminent HELLP syndrome. Other pregnancies were uneventful. Among the newborns, there were no FA positive tests, no congenital anomalies and all of them had normal growth and development. Patients remain alive with a median follow-up of 12 years after transplantation with normal hematological status. Conclusion. Fertility recovery after HSCT can result from incomplete depletion of the ovarian follicle reserve. HRT should begin promptly to prevent the early and late unwanted effects related to oestrogen deficiency after HSCT. Recovery of normal ovarian function and a viable pregnancy, is a realistic possibility even in Fanconi anemia patients following allogeneic SCT.

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Hematopoietic Stem Cell Transplantation for Sickle Cell Disease in Childhood: A Single Center Experience with 45 Patients

Blood ◽

10.1182/blood.v118.21.3103.3103 ◽

2011 ◽

Vol 118 (21) ◽

pp. 3103-3103 ◽

Cited By ~ 1

Author(s):

Laurence Dedeken ◽

Phu-Quoc Le ◽

Nadira Azzi ◽

Cecile Brachet ◽

Catherine Heijmans ◽

...

Keyword(s):

Bone Marrow ◽

Stem Cell ◽

Sickle Cell Disease ◽

Hematopoietic Stem Cell Transplantation ◽

Stem Cell Transplantation ◽

Cord Blood ◽

Sickle Cell ◽

Cell Disease ◽

Hematopoietic Stem

Abstract Abstract 3103 Despite improvement in medical management, sickle cell disease (SCD) is still associated with high risk of morbidity, chronic disability and early death. Allogeneic hematopoietic stem cell transplantation (HSCT) remains the only curative approach. Since November 1988, 45 patients (median age: 8.3 years; range: 1.7–15.3 years) with severe SCD underwent related HSCT in our unit. Thirty-five received bone marrow transplant, 3 cord blood, 6 bone marrow and cord blood and 1 peripheral blood stem cells. Two donors result from preimplantation genetic diagnosis with HLA selection. All were HLA-identical sibling except one who had one class II mismatch. All had one or more severe manifestations: 24 patients presented more than 2 vaso-occlusive crises per year, 11 recurrent acute chest syndrome, 19 cerebral vasculopathy and 4 erythroid alloimmunisation. Conditioning regimen consisted of the standard combination of busulfan, cyclophosphamide and from November 1991 antithymocyte globulins (ATG) were added: ATG Fresenius first and from July 2000 ATG Merieux. Since 1995 all patients were treated with hydroxyurea (HU) prior to transplantation for a median duration of 2.7 years (range: 0.8–10.7 years). Acute graft versus host disease (GVHD) was observed in 11 patients (3 grade III and 2 grade IV). Ten patients were treated for CMV reactivation and 4 for EBV reactivation. Only one patient had presented a probable invasive fungal disease. After median follow-up of 6.5 years, 10 patients had presented chronic GVHD, none was extensive. Only one required therapy beyond 2 years from transplant. Engraftment was successful in 42/45. One rejection occurred 15 months after transplantation. Since HU introduction before transplant (1995), no graft failure occurred. Important mixed chimerism is present in 2 patients (AA donor) who remain free of any sickle cell disease symptoms. Two deaths occurred: 1 unexplained death 6 years after HSCT in a child free of any treatment and 1 cerebral hemorrhage 18 days after transplant in a child with severe cerebral vasculopathy. Growth was normal after transplant. As expected, gonadal function was impaired in the majority of girls. However 3 girls had spontaneous normal puberty and one had two spontaneous pregnancies with normal outcome. Our results are very encouraging showing excellent outcomes. Both the overall survival (OS: 95.6%) and the event-free survival (EFS: 86.7%) are comparable to the other published studies, ranging from 93 to 97%, and 82 to 86 % respectively. Since 1995, all the 33 patients engrafted successfully. Previous treatment with HU may have contributed to successful engraftment. After 5.3 years of follow-up, their OS and EFS are both at 96.9%. The difference in outcome before and after 1995 is strongly significant for EFS (58.3% vs 96.9%, p=0.003). Severe cerebral vasculopathy with its risk of CNS hemorrhage remains a true challenge. Disclosures: No relevant conflicts of interest to declare.

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