Association of Nonmyeloablative Hematopoietic Stem Cell Transplantation With Neurological Disability in Patients With Relapsing-Remitting Multiple Sclerosis

Abstract

Among patients with relapsing-remitting MS, nonmyeloablative hematopoietic stem cell transplantation was associated with improvement in neurological disability and other clinical outcomes. These preliminary findings from this uncontrolled study require confirmation in randomized trials.

Autologous hematopoietic cell transplantation in multiple sclerosis

“…For this reason, steroids and paracetamol may be used after transplant to prevent or treat pyrexia, along with appropriate assessment and treatment of potential infections. Limiting fever during the per-transplant phase may help prevent or resolve this Uthoff-like phenomenon, in the short term and there may be longer term benefits, which need to be confirmed [30].…”

“…gov Identifier: NCT00273364]) and is anticipated to provide further evidence on the efficacy of ACHT in MS. Burt et al [30] is a follow-up study that uses the same patients who are in Burt et al [13], but with increased recruitment.…”

“…This study showed that at 3 years, the event-free survival in patients treated with AHCT was 78.4%, which is higher than that reported in the AFFIRM study for natalizumab. A large North American cohort study of 145 patients (123 RRMS and 28 SPMS), who failed standard disease-modifying therapies including natalizumab, found the 4-year relapse-free survival rate with AHCT to be 80% and NEDA rate to be 68% [30]. A Swedish study of 48 patients (34 RRMS) who had aggressive disease and had failed conventional treatment, including natalizumab, found the relapse-free survival rate to be 87% and a NEDA rate of 68% also [29].…”

“…A review of a cohort of 151 patients showed that the use of AHCT was associated with an improvement of the EDSS scored in patients with RRMS who had the disease for 10 years or less compared to those with SPMS and a longer disease duration [30]. A small cohort study in the Czech Republic (n = 26) found that AHCT has a more favorable outcome in patients who are not older than 35 years and have had the disease for less than 5 years [50].…”

“…Although AHCT is not normally offered to patients with significant long-term fixed disabilities, EDSS score prior to AHCT treatment was reported not to be a good predictor of outcome [50]. This is thought to be the case for the number of DMTs used before AHCT [30].…”