title: [Cell depletion and myoablation for neuroimmunological diseases].
abstract: BACKGROUND
  The treatment of autoimmune disorders of the nervous system is based on interventions for the underlying immune phenomena.
  
  
  OBJECTIVE
  To summarize concepts of cell depletion and myeloablation studied in the context of neuroimmunological disorders.
  
  
  METHODS
  Evaluation of the available literature on multiple sclerosis as the most widely studied neuroimmunological entity.
  
  
  RESULTS
  Three concepts have been introduced: classical immunosuppressants, such as azathioprine, mitoxantrone and cyclophosphamide exert general lymphopenic effects and thereby moderately decrease disease activity. Myeloablative regimens combined with autologous hematopoietic stem cell transplantation have a profound and in most cases long-lasting impact on autoimmunity at the cost of potentially life-threatening side effects. Alemtuzumab (anti-CD52), rituximab and ocrelizumab (both anti-CD20) are depleting antibodies directed against certain lymphocyte subsets and substantially ameliorate disease activity in relapsing-remitting multiple sclerosis. Ocrelizumab also shows efficacy in the primary progressive form of multiple sclerosis.
  
  
  CONCLUSIONS
  Most of the presented cell-depleting and myeloablative therapies are highly effective treatment options but are also accompanied by significant risks. In the context of the increasing number of alternative immunomodulatory options the indications for use should be cautiously considered.
authors.affiliation: Neurologische Klinik und Poliklinik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
authors.forename: M
authors.initials: M
authors.lastname: Diebold
authors.affiliation: Neurologische Klinik und Poliklinik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz.
authors.forename: L
authors.initials: L
authors.lastname: Kappos
authors.affiliation: Neurologische Klinik und Poliklinik, Universitätsspital Basel, Petersgraben 4, 4031, Basel, Schweiz. Tobias.Derfuss@usb.ch.
authors.forename: T
authors.initials: T
authors.lastname: Derfuss
mesh_terms: D000911:Antibodies, Monoclonal / Q000276:immunology / Q000627:therapeutic use*; D003131:Combined Modality Therapy / Q000379:methods; D019317:Evidence-Based Medicine; D018380:Hematopoietic Stem Cell Transplantation / Q000379:methods*; D006801:Humans; D007165:Immunosuppression Therapy / Q000379:methods*; D007166:Immunosuppressive Agents / Q000008:administration & dosage*; D009103:Multiple Sclerosis / Q000276:immunology* / Q000628:therapy*; D015213:Neuroimmunomodulation / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000911:Antibodies, Monoclonal; D007166:Immunosuppressive Agents
keywords: Hematopoietic stem cell transplantation; Immunosuppressive agents; Monoclonal antibodies; Multiple sclerosis; Neuroimmune mechanism