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Autologous stem cell transplant after immunosuppressive therapy induced 3 year remission in relapsing remitting multiple sclerosis patients
A new treatment for MS may stop the disease in its tracks in some patients. This high-dose therapy helped several MS patients.
A study of patients with relapsing-remitting multiple sclerosis (MS) found that many of those treated with high doses of medication to suppress their immune system (high-dose immunosuppressive therapy, or HDIT) plus a transplant of their own stem cells (hematopoietic cell transplant, or HCT) were disease-free several years later.
"[HDIT/HCT} may therefore represent a potential therapeutic option for patients with MS in whom conventional immunotherapy fails," wrote the authors of this study, led by Richard A. Nash, MD, of the Colorado Blood Cancer institute in Denver.
Before Dr. Nash and team put these cells back in the patients, they gave the patients high doses of the medications carmustine, etoposide, cytarabine and melphalan. This high-dose therapy decreased the patients's disease-causing immune cells so that the cells that were put back in could survive and help create an immune system that did not attack the nervous system.
Because there were risks associated with HDIT/HCT and some deaths were reported, an editorial about this study advised that patients should use caution when considering this treatment. The editorial was written by M. Mateo Paz Soldán, MD, PhD, of the University of Utah in Salt Lake City, and Brian G. Weinshenker, MD, of the Mayo Clinic in Rochester, MN.
"Although the mortality rate associated with HCT is low, any deaths attributable to treatment are difficult to accept in MS, considering ... its low mortality rate," Drs. Soldán and Weinshenker wrote.
Twenty-four patients with relapsing-remitting MS participated in this study.
MS is a disease of the nervous system in which the immune system attacks the coverings of nerves. This can damage brain function.
Patients with relapsing-remitting MS have periods — called relapses — where their neurologic function gets worse. During the relapse, patients with MS may have fatigue, numbness, vision problems, bowel and bladder problems, body stiffness, or problems with thinking or memory. These relapses are followed by periods when the symptoms partially or completely go away.
Stem cells can develop into many different cell types in the body. In this study, the patients' own stem cells were collected from their blood and the cells with potential to become healthy, functional immune cells were put back into the patients through their blood vessels.
In three years, 80 percent of the patients who received a stem cell transplant were MS-free. The 24 patients in the study experienced 94 serious reactions. Most of these reactions were infections or a decrease in the number of blood cells.
Dr. Nash and team noted that this study was meant to run for five years and is ongoing.
The study and editorial were published online Dec. 29 in JAMA Neurology.
The National Institute of Allergy and Infectious Diseases funded this research. Baxter Healthcare Corporation provided equipment and other supplies for this research.
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