Faculty Collaboration Database

T cell-depleted autologous hematopoietic stem cell transplantation for multiple sclerosis: report on the first three patients. Bone Marrow Transplant 1998 Mar;21(6):537-41

Date

05/30/1998

Pubmed ID

9543056

DOI

10.1038/sj.bmt.1701129

Scopus ID

2-s2.0-0031907910 (requires institutional sign-in at Scopus site)   101 Citations

Abstract

Multiple sclerosis (MS) is a disease of the central nervous system characterized by immune-mediated destruction of myelin. In patients with progressive deterioration, we have intensified immunosuppression to the point of myeloablation. Subsequently, a new hematopoietic and immune system is generated by infusion of CD34-positive hematopoietic stem cells (HSC). Three patients with clinical MS and a decline of their Kurtzke extended disability status scale (EDSS) by 1.5 points over the 12 months preceding enrollment and a Kurtzke EDSS of 8.0 at the time of enrollment were treated with hematopoietic stem cell (HSC) transplantation using a myeloablative conditioning regimen of cyclophosphamide (120 mg/kg), methylprednisolone (4 g) and total body irradiation (1200 cGy). Reconstitution of hematopoiesis was achieved with CD34-enriched stem cells. The average time of follow-up is 8 months (range 6-10 months). Despite withdrawal of all immunosuppressive medications, functional improvements have occurred in all three patients. We conclude that T cell-depleted hematopoietic stem cell transplantation can be performed safely in patients with severe and debilitating multiple sclerosis. Stem cell transplantation has resulted in modest neurologic improvements for the first time since onset of progressive disease although no significant changes in EDSS or NRS scales are evident at this time.

Author List

Burt RK, Traynor AE, Cohen B, Karlin KH, Davis FA, Stefoski D, Terry C, Lobeck L, Russell EJ, Goolsby C, Rosen S, Gordon LI, Keever-Taylor C, Brush M, Fishman M, Burns WH

MESH terms used to index this publication - Major topics in bold

Adult
Antigens, CD34
Combined Modality Therapy
Cyclophosphamide
Female
Granulocyte Colony-Stimulating Factor
Hematopoietic Stem Cell Transplantation
Humans
Immunosuppressive Agents
Methylprednisolone
Multiple Sclerosis
T-Lymphocytes
Transplantation Conditioning
Transplantation, Autologous
Whole-Body Irradiation