scholarly journals Nine-year follow up after hematopoietic stem cell transplantation in five multiple sclerosis patients

2019 ◽  
Vol 77 (8) ◽  
pp. 531-535 ◽  
Author(s):  
Elizabeth R. Comini-Frota ◽  
Bruna C. C. Marques ◽  
Caio Torres ◽  
Karoline M. S. Cohen ◽  
Eduardo Carvalho Miranda
Keyword(s):  
Multiple Sclerosis ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Disease Activity ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Disease Onset ◽  
Hematopoietic Stem ◽  
Relapsing Remitting

ABSTRACT Multiple sclerosis (MS) is an immune-mediated disease of the central nervous system. Its treatment has focused on inflammation control as early as possible to avoid disability. Autologous hematopoietic stem cell transplantation (AHSCT) has been used for treating MS since 1996, with recent decisive results regarding benefits in long-term efficacy. Five patients followed up at an MS center in Belo Horizonte, Brazil, who had relapsing-remitting MS with high disease activity, underwent AHSCT between 2009 and 2011. They were evaluated clinically, with magnetic resonance imaging, and by the EDSS every six months after transplantation, up to July 2018. The patients were four women and one man, with ages ranging from 25-50 years, and time since disease onset ranging from 4-17 years at the time of the procedure. Four patients improved, one patient was stabilized, and all patients were free of disease activity after 5-9 years. Through improving patient selection and decreasing the time from disease onset, AHSCT could stop epitope spreading and disease progression. Despite multiple other therapeutic choices being approved for relapsing-remitting MS, AHSCT continues to be a treatment to consider for aggressive MS disease.

Autologous hematopoietic stem cell transplantation for very active relapsing-remitting multiple sclerosis: report of two cases

2007 ◽  
Vol 13 (5) ◽  
pp. 676-678 ◽  
Author(s):  
E. Portaccio ◽  
M.P. Amato ◽  
G. Siracusa ◽  
F. Pagliai ◽  
S. Sorbi ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Hematopoietic Stem ◽  
Rescue Treatment ◽  
Relapsing Remitting ◽  
Relapsing Remitting Multiple Sclerosis

Autologous hematopoietic stem cell transplantation (AHSCT) has been proposed as a rescue treatment in multiple sclerosis (MS) patients not responding to first- or second-line therapies. To date, most of the treated cases had a secondary progressive disease course. However, patients with high inflammatory activity, but no secondary progression of the disease, could be candidates to take greater advantage of AHSCT. In this paper, we report two cases with very active, relapsing-remitting (RR) MS, who underwent AHSCT, and obtained a dramatic resolution to disease activity. Multiple Sclerosis 2007; 13: 676-678. http://msj.sagepub.com

Autologous hematopoietic stem cell transplantation in multiple sclerosis

Neurology ◽  
2017 ◽  
Vol 88 (22) ◽  
pp. 2115-2122 ◽  
Author(s):  
Maria Pia Sormani ◽  
Paolo A. Muraro ◽  
Irene Schiavetti ◽  
Alessio Signori ◽  
Alice Laroni ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Therapeutic Approach ◽  
Progression Rate ◽  
Hematopoietic Stem ◽  
Relapsing Remitting

Objective:To summarize the evidence on immunoablative therapy followed by autologous hematopoietic stem cell transplantation (aHSCT) to manage severe and treatment-refractory multiple sclerosis (MS).Methods:We collected all the published studies of aHSCT in any form of MS from 1995 to 2016, carefully excluding reports that were updated in subsequent studies. Endpoints were transplant-related mortality (TRM), rate of disease progression, and no evidence of disease activity (NEDA) status. A weighted metaregression based on a Poisson model was run, assessing whether there were study-specific characteristics with an effect on TRM and progression.Results:Fifteen studies including 764 transplanted patients were pooled in the meta-analysis. The pooled estimate of TRM was 2.1% (95% confidence interval [CI] 1.3%–3.4%). TRM was higher in older studies (p = 0.014) and in studies with a lower proportion of patients with relapsing-remitting MS (RRMS) (p = 0.028). A higher baseline Expanded Disability Status Scale (p = 0.013) was also significantly associated with a higher TRM. Pooled rate of progression was 17.1% at 2 years (95% CI 9.7%–24.5%) and 23.3% (95% CI 16.3%–31.8%) at 5 years. Lower 2-year progression rate was significantly associated with higher proportions of patients with RRMS (p = 0.004). The pooled proportion of NEDA patients at 2 years was 83% (range 70%–92%) and at 5 years was 67% (range 59%–70%).Conclusions:The emerging evidence on this therapeutic approach in MS indicates that the largest benefit/risk profile form this therapeutic approach can be obtained in patients with aggressive MS with a relapsing-remitting course and who have not yet accumulated a high level of disability.

scholarly journals Intensive immunosuppression followed by autologous hematopoietic stem cell transplantation for the treatment of multiple sclerosis

2020 ◽  
Vol 13 ◽  
pp. 175628642092946
Author(s):  
Jan Lycke ◽  
Stig Lenhoff
Keyword(s):  
Multiple Sclerosis ◽  
Clinical Trials ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Disease Activity ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Randomized Clinical Trials ◽  
Hematopoietic Stem

Autologous hematopoietic stem cell transplantation (AHSCT) to treat multiple sclerosis (MS) has mostly been used in devastating cases as the last option to stop further neurological deterioration. However, evidence from several retrospective clinical trials indicates that young, less disabled patients with highly inflammatory active MS are the most likely to benefit from AHSCT, and after moving from high-intensity to nonmyeloablative procedures the tolerability of AHSCT has increased and its associated risk and mortality have declined considerably. Recent meta-analyses and randomized clinical trials show that AHSCT is more effective than currently approved disease-modifying therapies (DMTs), with suppression of disease activity in 70–90% of patients and long-term cessation of disease activity in two-thirds of treated patients. The rationale for AHSCT is to eliminate autoimmunity and achieve immune resetting by intense immunosuppression followed by infusion of autologous hematopoietic stem cells. Similar effects on the immune system have been suggested for cladribine and alemtuzumab treatment and, together with AHSCT, they constitute the induction or immune-reconstitution therapies for MS. Although, further randomized controlled trials of AHSCT for MS are needed, it has become clear that improved patient selection and lower intensity conditioning regimens have reduced AHSCT associated risks and mortality and strengthened the position of AHSCT among other DMTs. Do we have enough experience and scientific support for AHSCT in MS to move from an exclusive treatment for aggressive, treatment-resistant MS and acquire broader indications, similar to other effective DMTs?

Autologous hematopoietic stem cell transplantation with reduced-intensity conditioning in multiple sclerosis

2012 ◽  
Vol 40 (11) ◽  
pp. 892-898 ◽  
Author(s):  
Jury L. Shevchenko ◽  
Alexey N. Kuznetsov ◽  
Tatyana I. Ionova ◽  
Vladimir Y. Melnichenko ◽  
Denis A. Fedorenko ◽  
...  
Keyword(s):  
Multiple Sclerosis ◽  
Stem Cell ◽  
Hematopoietic Stem Cell Transplantation ◽  
Stem Cell Transplantation ◽  
Cell Transplantation ◽  
Hematopoietic Stem Cell ◽  
Reduced Intensity Conditioning ◽  
Hematopoietic Stem ◽  
Reduced Intensity
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