More MS news articles for July 2001

Autologous Stem Cell Transplantation Abrogates Inflammatory Phase of MS

WESTPORT, CT (Reuters Health) Jul 17 - Autologous hematopoietic stem cell transplantation completely suppresses gadolinium (Gd)-enhanced MRI lesions in patients with severe, progressive multiple sclerosis (MS) that is refractory to conventional treatment, according phase I/II trial findings published in the July 10th issue of Neurology.

Dr. G. L. Mancardi of the University of Genova in Italy and associates report the results of 10 MS patients who underwent the procedure.

Mobilization with cyclophosphamide, 4 g/m², and granulocyte-colony-stimulating factor resulted in collection of a median 9.06 million CD34+ cells/kg.

The conditioning regimen, conducted 30 days to 40 days after mobilization, included carmustine, etoposide, cytosine-arabinoside, and melphalan. Two days after completion of the 5-day immunoablation, the stem cells were infused.

During the 3 months pre-transplantation, between 1 and 38 Gd-enhancing lesions were detected per month per patient. The number of lesions dropped to zero in eight patients in the month following conditioning therapy.

In only one patient was a new lesion detected in each of the first 3 months; the remaining patients exhibited no new lesions during the 4-to-30 months of follow-up, resulting in a highly significant difference between pre- and post-treatment (p < 0.000001).

Clinically, the patients were judged to be stable or slightly improved during follow-up, with one patient progressing after month 9. There were no major adverse events. Toxicities included asthenia in all cases, as well as fever in nine patients, transient liver enzyme increases in two patients, urinary tract infection in two, and cytomegalovirus reactivation in three.

Dr. Mancardi's group notes that the European Group for Blood and Marrow Transplantation Registry now includes 102 patients with severe MS who have been treated. Among these cases, there have been five fatalities due to complications related to the transplantation and two due to disease progression.

"The final impact of this procedure on the natural history of the disease remains to be established," the authors write. They conclude that autologous stem cell transplantation for patients with severe MS suppresses the breakdown of the blood-brain barrier and terminates the inflammatory phase of the disease.

Neurology 2001;57:62-68.

Copyright © 2001 Reuters Ltd