title: [Stem cell transplantation for multiple sclerosis. Hamburg experiences and state of international research].
abstract: BACKGROUND
  Autologous hematopoietic stem cell transplantation (aHSCT) is still not the standard treatment for highly inflammatory multiple sclerosis (MS). Even though randomized controlled trials are lacking, predictors for treatment response have been established. Since 2007, ten patients have received aHSCT in Hamburg.
  
  
  OBJECTIVE
  To present observational data from patients treated in Hamburg and a review of the literature.
  
  
  METHODS
  Descriptive statistics were used for evaluating the course of the expanded disability status scale (EDSS) as a measure for clinical outcome, magnetic resonance imaging (MRI) and neuropsychology. New gadolinium and T2-MRI uptake lesions per scan were compared. In addition, a systematic review of the currently available literature was performed.
  
  
  RESULTS
  The Hamburg series can be divided in two groups, one group including four patients with chronic progressive MS with low inflammatory activity (median EDSS = 6.25, 0.5 relapses per year, no gadolinium-enhancing lesions) and the other group including six patients with mild to moderate disability, relapses and inflammatory activity (median EDSS = 4.25, 1 relapse per year, 2 gadolinium-enhancing lesions). The median follow-up was 2.4 years. While the first group did not seem to benefit from aHSCT, an improvement in five out of six patients was observed in the second group. New T2 lesions occurred within the first 6 months but gadolinium-enhancing lesions were not observed (p < 0.05). A systematic literature search identified a higher efficacy of aHSCT in younger, less disabled MS patients with inflammatory activity, similar to the findings from Hamburg.
  
  
  CONCLUSIONS
  Cohort reports describe aHSCT as a safe and efficient treatment option in highly inflammatory MS. Based on these data aHSCT seems to be a reasonable option in selected patients with highly inflammatory MS but a randomized controlled trial is warranted.
authors.affiliation: Institut für Neuroimmunologie und Multiple Sklerose (INIMS) und Klinik und Poliklinik für Neurologie, Universitätsklinikum Hamburg-Eppendorf, Martinistr. 52, 20246, Hamburg, Deutschland, j.stellmann@uke.uni-hamburg.de.
authors.forename: J-P
authors.initials: JP
authors.lastname: Stellmann
authors.forename: K H
authors.initials: KH
authors.lastname: Stürner
authors.forename: F
authors.initials: F
authors.lastname: Ufer
authors.forename: S
authors.initials: S
authors.lastname: Havemeister
authors.forename: J
authors.initials: J
authors.lastname: Pöttgen
authors.forename: F
authors.initials: F
authors.lastname: Ayuk Ayuketang
authors.forename: N
authors.initials: N
authors.lastname: Kröger
authors.forename: M A
authors.initials: MA
authors.lastname: Friese
authors.forename: C
authors.initials: C
authors.lastname: Heesen
mesh_terms: D000328:Adult; D035843:Biomedical Research / Q000639:trends*; D019317:Evidence-Based Medicine; D005858:Germany; D006801:Humans; D038622:Internationality; D009103:Multiple Sclerosis / Q000175:diagnosis* / Q000628:therapy*; D009416:Nerve Regeneration; D033581:Stem Cell Transplantation / Q000379:methods* / Q000639:trends*; D016896:Treatment Outcome