Autologous Hematopoietic Stem-Cell Transplantation in Multiple Sclerosis: A Systematic Review and Meta-Analysis

Abstract

Introduction:In 1995, the use of autologous hematopoietic stem-cell transplantation (AHSCT), which was previously used to treat hematological tumors, was introduced for severe autoimmune diseases such as multiple sclerosis (MS). AHSCT has proven its safety over the past few years due to technical advances and careful patient selection in transplant centers. While most studies have reported that AHSCT led to decreased Expanded Disability Status Scale (EDSS) scores, some patients reported increased EDSS scores following the procedure. Given the contradictory results, we aimed to conduct a comprehensive systematic review and meta-analysis to investigate the efficacy and safety of AHSCT. Methods: PubMed, Web of Science, and Scopus were searched in March 2022 using a predefined search strategy. We included cohort studies, clinical trials, case-control studies, and case series that investigated the efficacy or safety of AHSCT in patients with MS. PICO in the present study was defined as follows: problem or study population (P): patients with MS; intervention (I): AHSCT; comparison (C): none; outcome (O): efficacy and safety.

The Place of Immune Reconstitution Therapy in the Management of Relapsing Multiple Sclerosis in France: An Expert Consensus

“…Randomised evaluations of aHSCT are lacking, and most information is from real-world analyses [ 87 ]. A recent meta-analysis (2022) showed that, compared with before treatment, aHSCT reduced the frequency of MS relapses, and MRI activity decreased disability (EDSS score), and promoted NEDA (68% of patients) [ 88 ]. Retrospective observational data suggest that aHSCT is effective in patients with insufficient response to previous IRT [ 89 ].…”

Central nervous system autoimmune diseases associated with COVID-19: Comprehensive review

“…Several studies have reported the development of ADs as a complication of SARS-CoV-2 infection. Acute transverse myelitis, autoimmune encephalitis, acute necrotizing myelitis, and CNS vasculitis are among ADs COVID-19 complications (10)(11)(12)(13). Bonometti et al reported the first case of systemic lupus erythematosus (SLE) following COVID-19 infection (14).…”

“…Second, high titer of IgG antineuronal autoantibodies in some cases (30), however, this observation seems to be controversial, since there were also reports of "antibody-negative" autoimmune encephalitis. Third, clinical resolution of symptoms after immunomodulatory treatments like steroid therapies (11).…”

“…Some of the patients experienced only mild respiratory symptoms while tested positive for COVID-19 and had serious neurologic manifestations (60), also cases with respiratory failure along with neurologic symptoms were reported as well (59). Most of the patients diagnosed with autoimmune encephalitis were presented with mild to moderate respiratory symptoms at onset, while the main reason for hospital admission was neurologic symptoms (especially seizures) (4,11,30,62,63,66). However, in some patients with comorbidities such as arterial hypertension or higher age, severe respiratory failure symptoms were observed (4,59,64).…”

“…Reports of AE due to COVID-19 mainly treated with methylprednisolone and IVIG (4,30,67). These patients are also administered antiseizure medications such as levetiracetam, clonazepam, and intravenous valproate sodium (11). In addition, other medications such as acyclovir, as an anti-viral drug, sertraline, and risperidone as medications for mood and mental disorders (30,67).…”