title: Hematopoietic SCT: a useful treatment for late metachromatic leukodystrophy.
abstract: In metachromatic leukodystrophy (MLD), the deficiency of the lysosomal enzyme arylsulfatase A (ARSA) leads to demyelination in the central and peripheral nervous system and ultimately to death. Allogeneic hematopoietic SCT (HSCT) is currently the only treatment for adult and late-onset juvenile MLD, although it is still in question because of insufficient follow-up. We wanted to determine whether HSCT could halt the progression of adult and late-onset juvenile MLD. Four treated unrelated patients and three untreated siblings were included in the study, and followed regularly for up to 18 years after transplantation. The patients were assessed from clinical examination, ARSA enzyme levels, magnetic resonance imaging of the brain and neuropsychological and neurophysiological tests. In the treated patients, ARSA levels were normal up to 18 years after transplantation. The parameters evaluated stabilized and remained stable after a latency period of 12-24 months. Two patients live normal lives, partially in a protected environment. The other two patients stabilized at a low cognitive and functional level. One of the controls is demented, one is in a vegetative state and one died. We conclude that, in comparison with their untreated siblings, HSCT halted the progression of the disease in our treated patients.
authors.affiliation: 1] Department of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden [2] Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Solders
authors.affiliation: Department of Neuroradiology, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: D A
authors.initials: DA
authors.lastname: Martin
authors.affiliation: 1] Department of Psychology, Karolinska University Hospital, Stockholm, Sweden [2] Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden.
authors.forename: C
authors.initials: C
authors.lastname: Andersson
authors.affiliation: 1] Department of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden [2] Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: M
authors.initials: M
authors.lastname: Remberger
authors.affiliation: Department of Clinical Neurophysiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: T
authors.initials: T
authors.lastname: Andersson
authors.affiliation: 1] Department of Therapeutic Immunology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden [2] Center for Allogeneic Stem Cell Transplantation, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: O
authors.initials: O
authors.lastname: Ringdén
authors.affiliation: 1] Department of Clinical Neurophysiology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden [2] Department of Neurology, Karolinska Institutet, Karolinska University Hospital, Stockholm, Sweden.
authors.forename: G
authors.initials: G
authors.lastname: Solders
mesh_terms: D000293:Adolescent; D000328:Adult; D064591:Allografts; D002553:Cerebroside-Sulfatase / Q000097:blood*; D005500:Follow-Up Studies; D018380:Hematopoietic Stem Cell Transplantation; D006801:Humans; D007966:Leukodystrophy, Metachromatic / Q000097:blood* / Q000000981:diagnostic imaging* / Q000628:therapy*; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011859:Radiography; D013997:Time Factors
chemical_list: D002553:Cerebroside-Sulfatase