Autologous haematopoietic stem-cell transplantation in multiple sclerosis

Summary Intense immunosuppression followed by autologous haematopoietic stem-cell transplantation has been assessed over the past few years as a possible new therapeutic strategy in severe forms of multiple sclerosis. Pioneering studies began in 1995, and since then, more than 400 patients worldwide...

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Bibliographic Details
Published in:Lancet neurology 2008-07, Vol.7 (7), p.626-636
Main Authors: Mancardi, Gianluigi, MD, Saccardi, Riccardo, MD
Format: Article
Language:English
Subjects:
Animals
Antigens
Autoimmune diseases
Bone marrow
Disease
Encephalomyelitis
Hematopoietic Stem Cell Transplantation - methods
Humans
Immune system
Immunology
Lymphocytes
Mortality
Multiple sclerosis
Multiple Sclerosis - mortality
Multiple Sclerosis - surgery
Neurology
Stem cells
Transplantation, Autologous - methods
Transplants & implants
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Summary:Summary Intense immunosuppression followed by autologous haematopoietic stem-cell transplantation has been assessed over the past few years as a possible new therapeutic strategy in severe forms of multiple sclerosis. Pioneering studies began in 1995, and since then, more than 400 patients worldwide have been treated with this procedure. Small uncontrolled studies show that about 60–70% of treated cases do not progress in the follow-up period of at least 3 years. Transplant-related mortality, which was 5–6% in the first reported series, has reduced in the past 5 years to 1–2%. Relapses dramatically decrease and inflammatory MRI activity is almost completely suppressed. Autologous haematopoietic stem-cell transplantation is associated with qualitative immunological changes in the blood, suggesting that, beyond its immunosuppressive potential, it could also have some beneficial effect for the resetting of the immune system. Patients with severe, rapidly worsening multiple sclerosis who are unresponsive to approved therapies could be candidates for this treatment, but its clinical efficacy has still to be shown in large, prospective, controlled studies.
ISSN:1474-4422
1474-4465
DOI:10.1016/S1474-4422(08)70138-8