Hematopoietic stem cell transplants for persons with multiple sclerosis: Is this the best therapeutic option?

Ruíz‐Argüelles, Guillermo J.; Gomez-Almaguer, D.

doi:10.1016/j.rmu.2017.10.003

Cited by 3 publications

(5 citation statements)

References 9 publications

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“…Our finding of an overall RR (either stabilization or improvement in the neurological condition) of 78% in all forms of MS is interesting, and similar to what has been published in other centers ; as expected, the overall RR varies in accordance with the type of MS: 83% in RRMS, 78% in PPMS and 73% in SPMS. These figures support our decision to graft individuals with all types of MS. Autografting yields favorable responses in 70–80% of patients in different parts of the world, while standard and novel drugs improve the patient’s clinical course and wellbeing in, at most, 50% of cases . The neurological response in MS can also be evaluated with the patient’s ‘disability progression’ which, in patients with an EDSS < 5·5, is defined as an increase of > 1·0, and in patients with an EDSS > 5·5 it reflects an increase > 0·5 .…”

Section: Discussionsupporting

confidence: 90%

“…Interestingly, some studies have reported good consistency when correlating self‐reported EDSS scores with physician‐assessed values . Our finding of an overall RR (either stabilization or improvement in the neurological condition) of 78% in all forms of MS is interesting, and similar to what has been published in other centers ; as expected, the overall RR varies in accordance with the type of MS: 83% in RRMS, 78% in PPMS and 73% in SPMS. These figures support our decision to graft individuals with all types of MS. Autografting yields favorable responses in 70–80% of patients in different parts of the world, while standard and novel drugs improve the patient’s clinical course and wellbeing in, at most, 50% of cases .…”

Section: Discussionsupporting

confidence: 87%

“…Additional studies are needed to both confirm the feasibility of the autografting method in patients with MS, as well as to assess the efficacy of the procedure and compare the results of auto‐HSCT with those obtained with other forms of immunosuppression .…”

Section: Discussionmentioning

confidence: 99%

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Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center

Ruíz‐Argüelles

Olivares‐Gazca

Olivares-Gazca

et al. 2019

Clinical and Experimental Immunology

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In order to reset the immune system to baseline function, autologous hematopoietic stem cell transplantation (HSCT) has been performed in patients with multiple sclerosis (MS). After June 2015, 617 new consecutive patients with MS were autografted in our center with non-frozen peripheral blood stem cells. The autografts were performed on an outpatient basis, after conditioning with cyclophosphamide and rituximab. The aim of the study was the assessment of both safety and efficacy of the method. The study's primary co-end-points were recovery of granulocyte and platelet counts and transplant-related mortality. Secondary endpoints were overall survival and clinical response (improvement or stabilization of the self-reported expanded disability status scale score). The protocol was registered in ClinicalTrials.gov identifier NCT02674217.0. We included 401 females and 216 males, with a median age of 46 years. A total of 259 patients had relapsing-remitting MS (RRMS), 228 had secondary progressive (SPMS) and 130 had primary progressive (PPMS) multiple sclerosis. All procedures were initially performed on an out-patient basis and only 32 individuals (5%) required hospitalization. One to three aphereses (median 1) were required to harvest at least 1 × 10 6 /kg viable CD34 + cells. The total number of viable CD34 + infused cells ranged between 1 and 37·83 × 10 6 /kg (median 5·68). Patients recovered more than 0·5 × 10 9 /l absolute granulocytes by day 8 (median, range = 2-14), and platelet values were above 20 × 10 9 /l by day 4 (median, range = 0-11). Eleven individuals required red blood cells and six needed platelet transfusions. To date, there have been no deaths attributable to the transplant, yielding a 30-month overall survival of 100%. Patients have been followed for 3-42 months (median = 12). The overall response rate (decrease or stabilization of the self-reported EDSS score) at 12 months was 78% for all patients (83% in RRMS, 78% in PPMS and 73% in SPMS), while the disability progression-free survival was 82% for all patients (86% in RRMS, 78·5% in SPMS and 78% in SPMS). Changes in the self-reported EDSS score in parallel with neurological improvement were observed in people with all types of MS after HSCT, employing the 'Mexican method' .

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Section: Discussionsupporting

confidence: 90%

Section: Discussionsupporting

confidence: 87%

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Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center

Ruíz‐Argüelles

Olivares‐Gazca

Olivares-Gazca

et al. 2019

Clinical and Experimental Immunology

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“…These data also indicate that the failure rate of HSCT in MS employing the “Mexican method” is around 20%, a figure substantially lower than that found using novel, expensive MS drugs ( 19 ) and very similar to the figures of other centers grafting MS patients employing other methods (see Figure 2 ), thus proving the efficacy of the “Mexican method.” Of important note, the long-term follow-up for this cohort is ongoing. Similar to other reports, we have observed fairly similar results and a potential trend of better outcomes in the relapsing form of MS. For instance, a systematic review with meta-analysis ( 20 ) of more than 750 patients showed that patients with relapsing-remitting MS had a significantly lower rate of progression and that response at 2 years was 83%.…”

Section: Reports On Response and Clinical Evaluationsupporting

confidence: 75%

The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge

et al. 2021

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After gaining experience conducting both auto and allografts in persons with hematological diseases in the HSCT programs in Puebla and Monterrey, México, this study outlines subsequent program autografting patients with autoimmune conditions. The first transplant in multiple sclerosis was conducted in Puebla on July 5, 2006. From 2015 we increased activity autografting persons with autoimmune conditions in the two campuses of the HSCT-México program: Puebla and Monterrey. By December 6, 2020, patient number 1,000 in the program was autografted. In our experience, a significant reduction in the expanded disability status scale score was achieved in all of the three phenotypes of the disease (from a median of 5.1 to 4.5 points), whereas the response rate (defined as a decrease of at least 0.5 of EDSS score regardless of baseline EDSS, or unchanged EDSS) was 83, 78, and 73% after 12 months in the relapsing-remitting, primary-progressive and secondary-progressive forms of multiple sclerosis, respectively. In addition to analyzing the viability, safety, and efficacy of our method, this study contributes new knowledge to the field of both stem cell transplantation and multiple sclerosis.

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“…While [56] mentioned that some autoimmune diseases like MS, associated with certain genotypes that increased risk of damage of islet beta cells and may lead to occurrence of diabetes. Moreover [57] stated that diabetes in multiple sclerosis contribute to the progression of MS and disability. [58,59] added that as MS progresses, patients encounter limitations; in their daily activities or working abilities.…”

Section: Discussionmentioning

confidence: 99%

Fatigue and Self-management among Multiple Sclerosis Patients

Shawli¹,

Abdulmutalib²,

Nagshabandi³

2019

AJNR

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Fatigue is considered as the most revealed symptoms in multiple sclerosis patients, reported by 88% of patients and has significant impact on all stages of life such as altering in daily living activity or psychosocial/mental functions. The pathogenesis of fatigue remain poorly understood and how its impact on self-management. The aim of study was to assess fatigue and self management among multiple sclerosis patients. A quantitative descriptive correlational design was used in this study. The study was conducted at both King Abdulaziz University Hospital and King Fahad Armed Forces Hospitals in Jeddah City from January till March 2018, data collected from outpatients' clinic and Inpatients' medical-wards. A convenience sample of 50 Multiple Sclerosis patients. Data was collected through the main one tool, it consists of three parts; Part I, Socio-demographic and clinical data constructed by the researchers. Part П, Modified Fatigue Impact scale; to assess the Impact of fatigue on physical, cognitive, and psychosocial functioning in patient with Multiple Sclerosis.. Part ПІ, Multiple Sclerosis Self Management Scale Revised; to provide a multidimensional and psychometrically assessment of self-management knowledge and behavior among Multiple Sclerosis patients. The study results showed there was a statistically significant negative correlations between fatigue subscales and overall self-management among Multiple Sclerosis patients with p-value (.019). Also, there was a statistically significant negative correlations between self-management factor scales and overall fatigue among Multiple Sclerosis patients with p-value (.019). It was concluded that there was a negative correlations between overall fatigue and overall self-management among Multiple Sclerosis patients, whenever fatigue severity increases, self-management decreases. It was a recommendation to encourage governmental policy and other decision makers in the Saudi community to develop periodically structure health education training program regarding self-management in MS and provide appropriate environments or facilities to conduct such programs, where nurses play a key role through health education and cooperate with other health care system.

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Hematopoietic stem cell transplants for persons with multiple sclerosis: Is this the best therapeutic option?

Cited by 3 publications

References 9 publications

Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center

Self-reported changes in the expanded disability status scale score in patients with multiple sclerosis after autologous stem cell transplants: real-world data from a single center

The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge

Fatigue and Self-management among Multiple Sclerosis Patients

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