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STUDY: Low intensity lympho-ablative regimen followed by autologous HSCT in severe MS

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  • STUDY: Low intensity lympho-ablative regimen followed by autologous HSCT in severe MS

    Low intensity lympho-ablative regimen followed by autologous hematopoietic stem cell transplantation in severe forms of multiple sclerosis: A MRI-based clinical study

    Daniela Curro’
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova; Italy
    Luisa Vuolo
    Careggi University Hospital, University of Firenze, Italy
    Francesca Gualandi
    Bone Marrow Transplantation Unit, San Martino Hospital, Genova, Italy
    Andrea Bacigalupo
    Bone Marrow Transplantation Unit, San Martino Hospital, Genova, Italy
    Luca Roccatagliata
    Department of Health Sciences and MRI Center for neurological diseases, University of Genova, Italy
    Elisabetta Capello
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova; Italy
    Antonio Uccelli
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova; Italy
    Riccardo Saccardi
    Careggi University Hospital, University of Firenze, Italy
    Maria Pia Sormani
    Department of Health Sciences, University of Genova, Italy
    Gianluigi Mancardi⇑
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health; University of Genova; Italy/Department of Health Sciences, University of Genova, Italy
    Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, MRI Center for neurological diseases, University of Genova, Italy

    Abstract

    Background: Autologous hematopoietic stem cell transplantation (AHSCT) has been successfully used to treat aggressive forms of multiple sclerosis (MS) that are unresponsive to approved therapies. In the last years, in view of the risk of mortality related to the procedure, the utilization of low-intensity conditioning regimens has been considered.

    Objective: To report magnetic resonance imaging (MRI) and clinical data in a small cohort of patients treated with a low-intensity lympho-ablative regimen, followed by AHSCT.

    Methods: Seven patients affected by relapsing–remitting MS (RRMS) underwent AHSCT, with cyclophosphamide 120 mg/kg in 2 days as the conditioning regimen; and were then followed with serial MRI evaluations until 36 months, with clinical evaluations until 60 months.

    Results: The mean number of gadolinium (Gd)-enhancing lesions significantly decreased after treatment, but a complete suppression of inflammatory activity was not obtained. No deaths occurred, but every patient developed adverse events, although not severe. After 5 years of follow-up, two patients remained stable, one patient markedly improved and four patients had a mild progression of the disease. Only one patient experienced a relapse after treatment.

    Conclusion: A low-intensity conditioning regimen with AHSCT has a profound effect on MRI inflammation and relapses, but is not able to completely abrogate MRI activity and disease progression of aggressive RRMS.
    Dave Bexfield
    ActiveMSers
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