Autologo us Hematopo i etic Stem Cells Transplantati on and its Current Role in Multiple Sclerosis Tre atment


Authors: E. Krasulová 1;  M. Trněný 2;  T. Kozák 3;  E. Havrdová 1
Authors‘ workplace: Ne urologická klinika 1. LF UK a VFN v Praze, 2I. interní klinika 1. LF UK a VFN v Praze, 3Oddělení klinické hematologi e 3. LF UK a FNKV, Praha 1
Published in: Cesk Slov Neurol N 2009; 72/105(3): 227-234
Category: Review Article

Overview

Multiple sclerosis (MS) is the most frequent a uto immune disorder of the central nervo us system in o ur ge ographical regi on. The dise ase can le ad to vari able degree of ne urological disability according to aggressiveness of MS co urse itself, e arly tre atment initi ati on and its invidividu al efficacy. In abo ut 3% of the pati ents MS co urse can be classifi ed as malignant with severe attacks from the beginning of the dise ase and rapid accumulati on of ne urological disability despite adequ ate tre atment. In such cases the tre atment with high‑dose immuno ablati on with a utologo us hema­topo i etic stem cells support (ASCT) sho uld be considered. The tre atment rati onale comprises the effort of a uto aggressive immune system eliminati on by high‑dose cytostatic tre atment followed by return of pati ents’ own hematopo i etic stem cells as reso urces for a new immune system. The aim is to enable reconstituti on of potenti ally less a uto aggressive immune system. The progressi on free survival 10 ye ars in 47% of the pati ents has been achi eved in the first ASCT gro up with the longest follow‑up since 1995 –  gre at result in comparison with any other currently available MS drug. More than 400 pati ents worldwide have been tre ated with ASCT procedure so far. Nowadays optimal indicati on for ASCT tre atment involves highly active MS within first five ye ars of the dise ase and ability to walk at le ast 100 metres witho ut aid. Despite its risks (including 2.3% mortality) ASCT presents promising tre atment for malignant MS with po or prognosis also in the Czech Republic, where ASCT rese arch –  still so needful and essenti al –  started in 1998.

Key words:
multiple sclerosis –  malignant –  immuno ablati on –  stem cell transplantati on –  ASCT


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