title: High-dose immunosuppressive therapy with autologous hematopoietic stem cell transplantation as a treatment option in multiple sclerosis.
abstract: High-dose immunosuppressive therapy (HDIT) with autologous hematopoietic stem cell transplantation (auto-HSCT) is a new and promising approach to the treatment of multiple sclerosis (MS) patients because currently there are no effective treatment methods for this disease. In this article, we present results of a prospective clinical study of efficacy of HDIT + auto-HSCT in MS patients. The following treatment strategies were employed in the study: "early," "conventional," and "salvage/late" transplantation. Fifty patients with various types of MS were included in this study. No toxic deaths were reported among 50 MS patients; transplantation procedure was well-tolerated by the patients. The efficacy analysis was performed in 45 patients. Twenty-eight patients achieved an objective improvement of neurological symptoms, defined as at least 0.5-point decrease in the Expanded Disability Status Scale (EDSS) score as compared to the baseline and confirmed during 6 months, and 17 patients had disease stabilization (steady EDSS level as compared to the baseline and confirmed during 6 months). The progression-free survival at 6 years after HDIT + auto-HSCT was 72%. Magnetic resonance imaging data were available in 37 patients before transplantation showing disease activity in 43.3%. No active, new, or enlarging lesions were registered in patients without disease progression. In conclusion, HDIT + auto-HSCT suggests positive results in management of patients with different types of MS. Identification of treatment strategies based on the level of disability, namely "early," "conventional," and "salvage/late" transplantation, appears to be feasible to improve treatment outcomes.
authors.affiliation: Pirogov National Medical Surgical Center, the Department of Haematology and Cellular Therapy, Pirogov National Medical Surgical Center, Moscow, Russia.
authors.forename: Yury L
authors.initials: YL
authors.lastname: Shevchenko
authors.forename: Andrei A
authors.initials: AA
authors.lastname: Novik
authors.forename: Aleksey N
authors.initials: AN
authors.lastname: Kuznetsov
authors.forename: Boris V
authors.initials: BV
authors.lastname: Afanasiev
authors.forename: Igor A
authors.initials: IA
authors.lastname: Lisukov
authors.forename: Vladimir A
authors.initials: VA
authors.lastname: Kozlov
authors.forename: Oleg A
authors.initials: OA
authors.lastname: Rykavicin
authors.forename: Tatyana I
authors.initials: TI
authors.lastname: Ionova
authors.forename: Vladimir Y
authors.initials: VY
authors.lastname: Melnichenko
authors.forename: Denis A
authors.initials: DA
authors.lastname: Fedorenko
authors.forename: Alexander D
authors.initials: AD
authors.lastname: Kulagin
authors.forename: Sergei V
authors.initials: SV
authors.lastname: Shamanski
authors.forename: Roman A
authors.initials: RA
authors.lastname: Ivanov
authors.forename: Gary
authors.initials: G
authors.lastname: Gorodokin
mesh_terms: D000293:Adolescent; D000328:Adult; D003131:Combined Modality Therapy; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007166:Immunosuppressive Agents / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D009103:Multiple Sclerosis / Q000628:therapy*; D012426:Russia; D014182:Transplantation, Autologous; D016896:Treatment Outcome
chemical_list: D007166:Immunosuppressive Agents