title: Autologous hematopoietic stem cell transplantation suppresses Gd-enhanced MRI activity in MS.
abstract: BACKGROUND
  Autologous hematopoietic stem cell transplantation (ASCT) has been recently utilized with encouraging results in patients with poorly controlled MS.
  
  
  OBJECTIVE
  To determine in severe cases of MS the effect of ASCT on gadolinium (Gd)-enhanced MRI and to obtain information on clinical course and safety.
  
  
  METHODS
  In a cooperative study, 10 patients with rapidly evolving secondary progressive MS were transplanted, after BEAM conditioning regimen (carmustine, etoposide, cytosine-arabinoside, and melphalan), with unmanipulated autologous peripheral blood SC mobilized with high-dose cyclophosphamide (CY; 4 g/m2) and granulocyte-colony-stimulating factor. Triple-dose Gd-enhanced scans were performed monthly for a pretreatment period of 3 months and compared with serial monthly Gd-enhanced MRI for the following 6 months and then once every 3 months.
  
  
  RESULTS
  The median follow-up is now 15 months (range 4 to 30 months). The number of Gd-enhancing lesions decreased immediately after mobilization with CY and finally dropped to zero in all cases after the conditioning regimen. The number of new T2-weighted positive lesions paralleled data obtained for Gd-enhanced MRI. Clinically, patients improved slightly or remained stable.
  
  
  CONCLUSIONS
  These results demonstrate that the therapeutic sequence CY-BEAM-ASCT has the capacity to completely suppress MR-enhancing activity, an effect that is sustained with time. The final impact of this procedure on disease course remains to be established.
authors.affiliation: Department of Neurological Sciences and Vision, University of Genova, Italy. neurolab@cisi.unige.it
authors.forename: G L
authors.initials: GL
authors.lastname: Mancardi
authors.forename: R
authors.initials: R
authors.lastname: Saccardi
authors.forename: M
authors.initials: M
authors.lastname: Filippi
authors.forename: F
authors.initials: F
authors.lastname: Gualandi
authors.forename: A
authors.initials: A
authors.lastname: Murialdo
authors.forename: M
authors.initials: M
authors.lastname: Inglese
authors.forename: M G
authors.initials: MG
authors.lastname: Marrosu
authors.forename: G
authors.initials: G
authors.lastname: Meucci
authors.forename: L
authors.initials: L
authors.lastname: Massacesi
authors.forename: A
authors.initials: A
authors.lastname: Lugaresi
authors.forename: F
authors.initials: F
authors.lastname: Pagliai
authors.forename: M P
authors.initials: MP
authors.lastname: Sormani
authors.forename: F
authors.initials: F
authors.lastname: Sardanelli
authors.forename: A
authors.initials: A
authors.lastname: Marmont
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002330:Carmustine / Q000627:therapeutic use; D003520:Cyclophosphamide / Q000627:therapeutic use; D003561:Cytarabine / Q000627:therapeutic use; D005047:Etoposide / Q000627:therapeutic use; D005260:Female; D005682:Gadolinium; D016178:Granulocyte-Macrophage Colony-Stimulating Factor / Q000627:therapeutic use; D018380:Hematopoietic Stem Cell Transplantation; D006412:Hematopoietic Stem Cells / Q000187:drug effects; D006801:Humans; D007089:Image Enhancement; D008279:Magnetic Resonance Imaging; D008297:Male; D008558:Melphalan / Q000627:therapeutic use; D008875:Middle Aged; D020528:Multiple Sclerosis, Chronic Progressive / Q000175:diagnosis* / Q000601:surgery*; D011300:Preoperative Care; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D003561:Cytarabine; D005047:Etoposide; D016178:Granulocyte-Macrophage Colony-Stimulating Factor; D003520:Cyclophosphamide; D005682:Gadolinium; D008558:Melphalan; D002330:Carmustine