Autologous hematopoietic stem cell transplantation in relapsing-remitting multiple sclerosis: comparison with secondary progressive multiple sclerosisReportar como inadecuado




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Neurological Sciences

, Volume 38, Issue 7, pp 1213–1221

First Online: 10 April 2017Received: 14 December 2016Accepted: 23 March 2017

Abstract

The main objective of our work is to describe the long-term results of myeloablative autologous hematopoietic stem cell transplant AHSCT in multiple sclerosis patients. Patients that failed to conventional therapies for multiple sclerosis MS underwent an approved protocol for AHSCT, which consisted of peripheral blood stem cell mobilization with cyclophosphamide and granulocyte colony-stimulating factor G-CSF, followed by a conditioning regimen of BCNU, Etoposide, Ara-C, Melphalan IV, plus Rabbit Thymoglobulin. Thirty-eight MS patients have been transplanted since 1999. Thirty-one patients have been followed for more than 2 years mean 8.4 years. There were 22 relapsing-remitting multiple sclerosis RRMS patients and 9 secondary progressive multiple sclerosis SPMS patients. No death related to AHSCT. A total of 10 patients 32.3% had at least one relapse during post-AHSCT evolution, 6 patients in the RRMS group 27.2% and 4 in the SPMS group 44.4%. After AHSCT, 7 patients 22.6% experienced progression of disability, all within SP form. By contrast, no patients with RRMS experienced worsening of disability after a median follow-up of 5.4 years, 60% of them showed a sustained reduction in disability SRD, defined as the improvement of 1.0 point in the expanded disability status scale EDSS sustains for 6 months 0.5 in cases of EDSS ≥ 5.5. The only clinical variable that predicted a poor response to AHSCT was a high EDSS in the year before transplant. AHSCT using the BEAM-ATG scheme is safe and efficacious to control the aggressive forms of RRMS.

KeywordsAutologous hematopoietic stem cell transplantation Multiple sclerosis Secondary progressive multiple sclerosis Immunotherapy Immunosupression Neurodegeneration  Download fulltext PDF



Autor: Bonaventura Casanova - Isidro Jarque - Francisco Gascón - Juan Carlos Hernández-Boluda - Francisco Pérez-Miralles - Javie

Fuente: https://link.springer.com/







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