Autologous hematopoietic stem cell transplantation in multiple sclerosis: 20 years of experience

Abstract

Intense immunosuppression followed by autologous hematopoietic stem cell transplantation (AHSCT) has been widely used in the last 20 years for the treatment of aggressive forms of autoimmune disorders, especially multiple sclerosis (MS). All clinical studies, although small and uncontrolled, demonstrate a great efficacy of this procedure in halting inflammation and disease activity, even in those patients affected by "malignant forms" of MS. The long-term follow-up has also revealed the possible maintenance of positive results in the course of time, and this evidence is supported by immunological data that suggest the possibility of a resetting of the immune system after AHSCT. The safety of AHSCT has improved in the last years, but the transplant related mortality is still nowadays of about 1-2 %, pointing out that a careful selection of patients to submit to AHSCT is mandatory. The long clinical experience allowed to identify the ideal candidate: a young patient, with a short disease duration, with recurring and disabling relapses and the presence of inflammatory activity on brain magnetic resonance scans, unresponsive to approved therapies. A large, randomized clinical study comparing AHSCT with the best approved therapies is still necessary to confirm the role of transplantation in MS treatment.

Hematopoietic Cell Transplantation for Autoimmune Diseases: A Review of History, Current State, and Future Issues

“…Summarizing the cited protocols, with domination of BEAM and Cy (200 mg/kg), both ±ATG/ alemtuzumab make an impression that in case of MS, lower intensity protocols demonstrate lower, up to 0%, mortality rate, while OS and progression-free survival are similar; in resent studies, they range from 65 to 100%, far better than the results of conventional MS therapies [77][78][79][80][81]. Our limited experience demonstrates 71% of progression-free survival after nonmyeloablative transplantations performed in Hadassah-HUJI Medical Center (14 patients, 1998-2016, 12 after autologous and 2 after allogeneic transplantation; S. Savin, R. Or, M. Shapira and I. Resnick; unpublished data).…”

Investigation of Tissue Engineering Scaffolds for Potential Medical Applications

“…The use of autologous stem cells reduces the risk of rejection [21], ensures better regeneration [22], and ASCs are readily available. ASCs are easy to harvest in a safe, minimally invasive way from almost any patient.…”

“…MPExSL is a novel RP STL method developed by the LML laboratory in IIT, Genova. The method relies on a layer-by-layer buildup process where layers are fabricated by image projection, using pulsed excimer laser radiation [21][22][23][24]. A schematic representation of the system and a photo of the actual apparatus are shown in Figure 3.…”

“…The polymer was purified by methylene chloride, followed by water and brine. Sodium sulphate was used as a drying agent of the organic phase, and finally, the PPF was made solvent-free via a rotary evaporator [22]. To have an appropriate viscosity for STL purposes, the purified PPF resin had to be diluted.…”

“…To have an appropriate viscosity for STL purposes, the purified PPF resin had to be diluted. Diethyl fumarate (DEF) was applied as diluent to reduce the resin viscosity as needed for proper resin recast [21][22][23][24]. …”