147CD34+ selected autologous peripheral blood stem cell transplantation for multiple sclerosis (MS): Report of toxicity and treatment results at one year of follow-up in 15 patients

Carreras, Enric; Sáiz, Albert; Marı́n, Pedro; Martı́nez, Constantino; Rovira, Montse; Villamor, Neus; Aymerich, Marta; Lozano, Marisa; Fernández‐Avilés, Francisco; Urbano-Ispizúa, Álvaro; Montserrat, Emili; Graus, Francesc

doi:10.1016/s1083-8791(03)80148-9

Cited by 49 publications

(58 citation statements)

References 0 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…18,20,23,24 In the present study, CD34+ selection did not improve disease control after AHSCT. Unexpectedly, we detected a trend toward better outcomes in non-selected patients, with lower relapse rates and higher PFS.…”

Section: Resultscontrasting

confidence: 60%

Does ex vi vo CD34+ positive selection influence outcome after autologous hematopoietic stem cell transplantation in systemic sclerosis patients?

Soga

Labopin

Henes

et al. 2015

Bone Marrow Transplant

View full text Add to dashboard Cite

This EBMT Autoimmune Disease Working Party study aimed to evaluate the influence of CD34+ positive graft selection (CD34+) on the outcome of systemic sclerosis (SSc) patients after autologous hematopoietic stem cell transplantation (AHSCT). Clinical and laboratory data from 138 SSc patients at diagnosis, before and after AHSCT were retrospectively analyzed. CD34+ selection was performed in 47.1% (n = 65) patients. By multivariate analysis adjusting for all factors differing between the two groups (without or with CD34+), there was no statistically significant difference in terms of overall survival (hazard ratio (HR): 0.98, 95% confidence interval (CI) 0.40-2.39, P = 0.96), PFS (HR: 1.55, 95% CI 0.83-2.88, P = 0.17) and incidence of relapse or progression (HR: 1.70, 95% CI 0.85-3.38, P = 0.13). We demonstrate that CD34+ does not add benefit to the outcome of SSc patient treated with AHSCT. These findings should be further confirmed by prospective randomized trials.

show abstract

Section: Resultscontrasting

confidence: 60%

Does ex vi vo CD34+ positive selection influence outcome after autologous hematopoietic stem cell transplantation in systemic sclerosis patients?

Soga

Labopin

Henes

et al. 2015

Bone Marrow Transplant

View full text Add to dashboard Cite

show abstract

“…Less intensive regimens, such as cyclophosphamide with ATG, have resulted in the reduction of signs of CNS inflammation; however, some of these patients breakthrough and experience ongoing relapses after HSCT. Clinical relapses or magnetic resonance imaging evidence of ongoing CNS relapse were seen in 38 % of recipients during the 3 years after HSCT [15,49]. The use of higher intensity conditioning regimens, such as BEAM with ATG or busulphan/cyclophosphamide with ATG, is effective at suppressing episodic CNS inflammation.…”

Section: Lesson 4: Hsct Is More Likely To Be Effective For Ms Patientmentioning

confidence: 99%

“…& Patients undergoing HSCT for a malignancy who also have concurrent MS [10][11][12] & The initial prospective phases 1 and 2 cohort trials [13][14][15][16][17] & Reports of registry [18] based data for the treatment of MS This information is summarized in a number of review articles [19,20].…”

mentioning

confidence: 99%

“…Graft cell composition can be altered using ex vivo cell selection or depletion technology. Immunomagnetic CD34 cell selection rigorously depletes grafts of immune cells to prevent reintroduction of autoreactive cells [16,17,[30][31][32][33]. The in vivo purging of lymphocytes could be accomplished by treating the patient with anti-thymocyte globulin, rituximab, or alemtuzumab prior to leukopheresis.…”

mentioning

confidence: 99%

See 1 more Smart Citation

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

Atkins

Freedman

2013

Neurotherapeutics

View full text Add to dashboard Cite

Reports from more than 600 hematopoietic stem cell transplants (HSCT) have appeared in the medical literature for the last 1 and one-half decades. The patient's own stem cells are harvested and stored temporarily while high doses of chemotherapy and biologics are used to destroy the auto-destructive immune system. The immune system is regenerated from the infused autologous hematopoietic stem cells. Increasing clinical experience has refined patient selection criteria and management in the peri-transplant period leading to a reduction in treatment-related complications. HSCT, when used to treat patients with aggressive highly active multiple sclerosis, can reduce or eliminate ongoing clinical relapses, halt further progression, and reduce the burden of disability in some patients, in the absence of chronic treatment with disease-modifying agents. The top 10 lessons learned from the growing experience using HSCT for the treatment of multiple sclerosis are discussed.Keywords Hematopoietic stem cell transplantation . Multiple sclerosis . Autoimmunity . Immune ablation There are published reports of more than 600 bone marrowbased transplants performed primarily for the treatment of multiple sclerosis (MS). This review will focus on why and how the hematopoietic stem cell transplantation (HSCT) procedure is used and discuss some of the lessons that can be gleaned from the experience of using HSCT to treat MS.MS is an organ-specific autoimmune disease that results in exclusive central nervous system (CNS) demyelination and axonal damage. Early on, multifocal localized pockets of inflammation lead to transient neurologic dysfunction manifesting as a series of relapses followed by remissions, usually with complete recovery owing to adequate CNS repair. However, as the damage accumulates, repair becomes inadequate and leads to incomplete resolution of disability, culminating in a neurodegenerative process amid a sea of smoldering and changing inflammation. This is probably the underlying state for the clinical stage of secondary progressive MS (SP-MS), a phase characterized by relentless and progressive accumulation of neurological disability with dwindling evidence of discrete relapses [1].Targeting inflammation with interferon-β, glatiramer acetate, natalizumab, fingolimod, and other immune-modulating agents reduces the frequency of relapses, but the impact on delaying the onset, preventing or slowing the tempo of SP-MS remains uncertain [2][3][4]. Several other drugs are in late stage clinical trials and may provide new alternatives for some patients with relapsing-remitting MS (RR-MS). However, despite these therapeutic advances, a subset of patients seem refractory and rapidly develop severe neurological impairment, whereas other patients may have a slower progression of illness that ultimately results in marked functional disabilities. Only a single agent, mitoxantrone, has been shown to temporarily halt or slow the tempo of SP-MS [5,6], but even then, this occurs only in SP-MS patients who have highly act...

show abstract

“…34 The mortality rate of HSCT for MS in studies with relatively large samples is described in Table 1. [25][26][27][28][29][30][35][36][37][38][39][40][41][42][43][44][45] Although these studies use myeloablative conditioning regimens of varying intensity, non-myeloablative regimens have been advocated for autologous HSCT of autoimmune diseases. 46 Recently, one of these latter studies was published using CY/rATG and it reported no deaths among 21 patients with relapsing-remitting MS. 31 There is a controversy regarding the analysis of the immune system modifications as increases in naive CD4 þ T cells over memory cells 20 and the fact that more intensive regimens seem to present better results than less intensive regimens.…”

Section: Introductionmentioning

confidence: 99%

Brazilian experience with two conditioning regimens in patients with multiple sclerosis: BEAM/horse ATG and CY/rabbit ATG

Hamerschlak

Rodrigues

Moraes

et al. 2009

Bone Marrow Transplant

View full text Add to dashboard Cite

Studies have shown that autologous hematopoietic SCT (HSCT) can be used as an intensive immunosuppressive therapy to treat refractory patients and to prevent the progression of multiple sclerosis (MS). This is a prospective multicentric Brazilian MS trial comparing two conditioning regimens: BEAM/horse ATG and CY/ rabbit ATG. Most (80.4%) of the 41 subjects in the study had the secondary progressive MS subtype and the mean age was 42 years. The baseline EDSS score in 58.5% of the subjects was 6.5 and 78% had a score of 6.0 or higher, respectively. The complication rate during the intratransplantation period was 56% for all patients: 71.4% of the patients in the BEAM/hATG group and 40% in the CY/rATG group (P ¼ 0.04). Three subjects (7.5%) died of cardiac toxicity, sepsis and alveolar hemorrhage, all of them in the BEAM/ATG group. EFS was 58.54% for a ll patients: 47% in the BEAM/hATG group and 70% in the CY/rATG group (P ¼ 0.288). In conclusion, the CY/rATG regimen seems to be associated with similar outcome results, but presented less toxicity when compared with the BEAM/hATG regimen. Long-term followup would be required to fully assess the differences in therapeutic effectiveness between the two regimens.

show abstract

147CD34+ selected autologous peripheral blood stem cell transplantation for multiple sclerosis (MS): Report of toxicity and treatment results at one year of follow-up in 15 patients

Cited by 49 publications

References 0 publications

Does ex vi vo CD34+ positive selection influence outcome after autologous hematopoietic stem cell transplantation in systemic sclerosis patients?

Does ex vi vo CD34+ positive selection influence outcome after autologous hematopoietic stem cell transplantation in systemic sclerosis patients?

Hematopoietic Stem Cell Therapy for Multiple Sclerosis: Top 10 Lessons Learned

Brazilian experience with two conditioning regimens in patients with multiple sclerosis: BEAM/horse ATG and CY/rabbit ATG

Contact Info

Product

Resources

About