Severe Multiple Sclerosis (MS) May Be Controlled with High Dose Immunosuppressive Therapy (HDIT) and Autologous Stem Cell Transplantation (SCT).
|Title||Severe Multiple Sclerosis (MS) May Be Controlled with High Dose Immunosuppressive Therapy (HDIT) and Autologous Stem Cell Transplantation (SCT).|
|Publication Type||Journal Article|
|Authors||Kraft GH, Bowen JD, Sullivan KM, McSweeney PA, Pavletic S, Al-Omaishi J, Corboy JR, Holmberg LA, Openshaw H, Prather K, Ryan K, Storek J, Zunt JR, Nash RA|
|Journal||International Journal of MS Care|
In order to determine whether severe, non-responsive MS may be controlled with HDIT and rescue with SCT, six (6) patients with primary progressive MS, fifteen (15) patients with secondary progressive MS, and one (1) patient with relapsing remitting MS were studied. These 22 patients had a median age of 44 (range 27-60) years, and a median EDSS at HDIT of 7.0 (range 5.0-8.0). Eligibility requirements included an EDSS from 5.0 to 8.0 and deterioration of one (1) or more points over the previous year. The median follow-up was nine (9) (range 1-24) months. Nineteen (19) patients were considered evaluable at three (3) or more months after transplant. At last evaluation, three (3) patients had a confirmed increase of EDSS of at least 0.5 points, five (5) patients had a decrease in EDSS of at least 0.5 points and 11 patients have remained stable. New or enhancing lesions have been observed on MRI of the brain after transplantation in only one (1) patient with a flare of MS associated with the administration of granulocyte-colony stimulating factor (G-CSF). No patient has received further treatment with interferon beta or copaxone after transplantation. Complications included one (1) patient with a MS flare during administration of G-CSF for mobilization. Another patient, the only patient who received rabbit anti-thymocytic globulin (ATG) due to a positive skin test to horse ATG, developed an Epstein-Barr virus associated post-transplant lymphoproliferative disorder and died at day 53, and another patient had a sustained fever of unknown origin and had an increase in the baseline EDSS of 7.5 to 8.5 at 3 months. We believe that HDIT/SCT may control severe, refractory MS and should continue to be studied.