Journal Article

High-dose immunoablation with autologous haematopoietic stem cell transplantation in aggressive multiple sclerosis: a single centre 10-year experience

Kovářová, Ivana, Trněný, Marek, Pohlreich, David, Havrdová, Eva, Vacková, Blanka, Kozák, Tomáš, Lhotáková, Petra, Kemlink, David, Krasulová, Eva, Kobylka, Petr

2010

Overview

There are multiple sclerosis patients who suffer from an aggressive course of the disease with severe relapses and rapid accumulation of disability despite adequate treatment. In such cases high-dose immunoablation with autologous haematopoietic stem cell transplantation (ASCT) may be considered. Our objective was to report our experience with 26 multiple sclerosis patients treated with ASCT within the years 1998—2008. Twenty-six patients (Expanded Disability Status Scale 2.5—7.5 (median 6.0), multiple sclerosis duration 2—19 years (median 7)) with aggressive multiple sclerosis underwent autologous haematopoietic stem cell transplantation. Stem cells were mobilized by high-dose cyclophosphamide and granulocyte colony-stimulating factor, BEAM (carmustine, etoposide, cytarabine, melphalan) was used for immunoablation. Patients were evaluated at baseline and every six months post ASCT for adverse events and clinical outcome. Follow-up period was 11—132 months (median 66). Progression-free survival was calculated using the Kaplan— Meier method. At 3 and 6 years of follow-up 70.8% and 29.2% of patients respectively were free of progression. Patients with relapsing multiple sclerosis course, disease duration <5 years and age <35 years had a more favourable outcome. There was no death within 100 days after ASCT. We conclude that ASCT represents a viable and effective treatment option for aggressive multiple sclerosis.

• Publisher: SAGE Publications,Sage Publications,Sage Publications Ltd
• Subject: Adult / Age Factors / Antineoplastic Combined Chemotherapy Protocols / Biological and medical sciences / Carmustine / Combined Modality Therapy / Cyclophosphamide - therapeutic use / Cytarabine / Degenerative and inherited degenerative diseases of the nervous system. Leukodystrophies. Prion diseases / Disease-Free Survival / Etoposide / Female / Granulocyte Colony-Stimulating Factor - therapeutic use / Hematopoietic Stem Cell Transplantation / Humans / Immunosuppression - methods / Kaplan-Meier Estimate / Male / Medical sciences / Melphalan / Multiple Sclerosis - therapy / Multiple sclerosis and variants. Guillain barré syndrome and other inflammatory polyneuropathies. Leukoencephalitis / Neurology / Treatment Outcome