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Immunoablation and haematopoietic stem cell transplantation completely aborts inflammation in aggressive relapsing forms of MS
M.S. Freedman, H. Atkins, M.J. Bowman, H. MacLean, C. Rush The Ottawa Hospital, Ottawa, ON, Canada
Background: We have been using a standard regimen of immunoablation and haematopoietic stem cell transplantation for the treatment of aggressive forms of relapsing MS that typically are poor responders to first or second line treatments.
Objective: To report on the experience obtained at our centre since the completion of a previously reported phase II trial.
Methods: Patients (n= 41) with aggressive forms of relapsing MS were identified from the MS clinic of The Ottawa Hospital and haematopoietic stem cells were mobilized with cyclophosphamide and filgrastim, collected by leukophoresis and CD34+ stem cells isolated by immunomagnetic separation. Immunoablation was accomplished using high dose cyclophosphamide and busulphan followed by rabbit anti-thymocyte globulin. Routine post-transplant antibiotics, antiviral and antifungal agents along with IVIG were administered for up to a year.
Results: We have now treated a total of 41 patients; 24 were previously reported as part of a longstanding study, and 17 were treated since the completion of enrollment into the study. Baseline characteristics of these post-study patients were similar in age (mean 31, range 20-51), duration of MS (mean 4.2 years, range 5 months-10.3 years), baseline EDSS (mean 4.0, range 1.5-7.5), as the study patients and a median follow-up of 2.8 years (range 2 months-13 years), though patients were not followed as part of a pre-planned prospective study. Similar to the study patients, not a single subsequent relapse or new MRI lesion was noted. Some patients showed progression but the majority were stable or showed improvements (76%). There were no unusual post-transplant complications noted (autoimmune thyroiditis n=3, deep vein thrombosis n=1 and shingles n=1).
Conclusions: These results continue to support the treatment option of immunoablation and haematopoietic stem cell transplantation for a particularly aggressive subgroup of relapsing MS patients.
M.S. Freedman, H. Atkins, M.J. Bowman, H. MacLean, C. Rush The Ottawa Hospital, Ottawa, ON, Canada
Background: We have been using a standard regimen of immunoablation and haematopoietic stem cell transplantation for the treatment of aggressive forms of relapsing MS that typically are poor responders to first or second line treatments.
Objective: To report on the experience obtained at our centre since the completion of a previously reported phase II trial.
Methods: Patients (n= 41) with aggressive forms of relapsing MS were identified from the MS clinic of The Ottawa Hospital and haematopoietic stem cells were mobilized with cyclophosphamide and filgrastim, collected by leukophoresis and CD34+ stem cells isolated by immunomagnetic separation. Immunoablation was accomplished using high dose cyclophosphamide and busulphan followed by rabbit anti-thymocyte globulin. Routine post-transplant antibiotics, antiviral and antifungal agents along with IVIG were administered for up to a year.
Results: We have now treated a total of 41 patients; 24 were previously reported as part of a longstanding study, and 17 were treated since the completion of enrollment into the study. Baseline characteristics of these post-study patients were similar in age (mean 31, range 20-51), duration of MS (mean 4.2 years, range 5 months-10.3 years), baseline EDSS (mean 4.0, range 1.5-7.5), as the study patients and a median follow-up of 2.8 years (range 2 months-13 years), though patients were not followed as part of a pre-planned prospective study. Similar to the study patients, not a single subsequent relapse or new MRI lesion was noted. Some patients showed progression but the majority were stable or showed improvements (76%). There were no unusual post-transplant complications noted (autoimmune thyroiditis n=3, deep vein thrombosis n=1 and shingles n=1).
Conclusions: These results continue to support the treatment option of immunoablation and haematopoietic stem cell transplantation for a particularly aggressive subgroup of relapsing MS patients.