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Old 05-01-2017, 11:18 AM
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Default STUDY: Autologous hematopoietic stem cell transplantation in MS: A meta-analysis

Neurology. 2017 Apr 28.

pii: 10.1212/WNL.0000000000003987. doi: 10.1212/WNL.0000000000003987. [Epub ahead of print]

Autologous hematopoietic stem cell transplantation in multiple sclerosis: A meta-analysis.

Sormani MP1, Muraro PA2, Schiavetti I2, Signori A2, Laroni A2, Saccardi R2, Mancardi GL2.

Abstract

OBJECTIVE:
To summarize the evidence on immunoablative therapy followed by autologous hematopoietic stem cell transplantation (aHSCT) to manage severe and treatment-refractory multiple sclerosis (MS).

METHODS:
We collected all the published studies of aHSCT in any form of MS from 1995 to 2016, carefully excluding reports that were updated in subsequent studies. Endpoints were transplant-related mortality (TRM), rate of disease progression, and no evidence of disease activity (NEDA) status. A weighted metaregression based on a Poisson model was run, assessing whether there were study-specific characteristics with an effect on TRM and progression.

RESULTS:
Fifteen studies including 764 transplanted patients were pooled in the meta-analysis. The pooled estimate of TRM was 2.1% (95% confidence interval [CI] 1.3%-3.4%). TRM was higher in older studies (p = 0.014) and in studies with a lower proportion of patients with relapsing-remitting MS (RRMS) (p = 0.028). A higher baseline Expanded Disability Status Scale (p = 0.013) was also significantly associated with a higher TRM. Pooled rate of progression was 17.1% at 2 years (95% CI 9.7%-24.5%) and 23.3% (95% CI 16.3%-31.8%) at 5 years. Lower 2-year progression rate was significantly associated with higher proportions of patients with RRMS (p = 0.004). The pooled proportion of NEDA patients at 2 years was 83% (range 70%-92%) and at 5 years was 67% (range 59%-70%).

CONCLUSIONS:
The emerging evidence on this therapeutic approach in MS indicates that the largest benefit/risk profile form this therapeutic approach can be obtained in patients with aggressive MS with a relapsing-remitting course and who have not yet accumulated a high level of disability.

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Old 05-01-2017, 12:15 PM
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Barts MS Blog has some good thoughts on this latest analysis. They don't pull any punches. - D

Quote:
It is not surprising as you are taking a sledge hammer to the immune system. Removing it and replacing it and disease becomes silenced in many people. However, it fails in a significant proportion, is this because of brain activity not touched by the treatment or was the treatment started to late. This likewise justifies the pharma approach of attacking the immune system and so anyone that thinks these treatments do nothing are deluding themselves....(Bruv:-).

http://multiple-sclerosis-research.b...is+Research%29
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