Introduction Multiple sclerosis (MS) is a T-cell-mediated chronic inflammatory disorder of the central nervous system. Several agents have been approved for treatment of MS, however their efficacy is limited and short term. Autologous haematopoietic stem cell (HSC) transplantation may remain an encouraging option for some MS patients who failed prior conventional treatment. Objective To assess the safety and effectiveness of HSCs mobilization in patients with MS.
Kyrcz-Krzemień S, Helbig G, Torba K, Koclęga A, Krawczyk-Kuliś M. Safety and efficacy of haematopoietic stem cells mobilization in patients with multiple sclerosis. Hematology. 2016 Feb. [Epub ahead of print]
Material and methods Thirty-nine patients (20 females, 19 males) with relapsing-remitting MS at median age of 40 years (range 25-63) were included in this study. As a stem cell mobilization they received either granulocyte colony-stimulating factor (G-CSF) alone (10 μg/kg s.c. daily; n = 1) or cyclophosphamide (CY; 2.0 g/m2 i.v. on days 1-2) followed by G-CSF (n = 38).
Results The median number of mobilized HSCs per kilogram was 6.32 × 106 (range 2.64-26.3 × 106). One apheresis was sufficient for collection of HSCs in 30 out of 39 MS patients (77%). Two aphereses were required for seven patients, three for one patient, and four for one patient (17, 3, and 3%, respectively).
Side effects of HSCs mobilization have been reported for eight patients (30%) and they were as follows: Staphylococcus epidermidis bacteremia (n = 1), fever of unknown origin (n = 3), diarrhea (n = 3), and headache (n = 1).
Conclusions Mobilization using CY and/or G-CSF resulted in effective mobilization in all MS patients. This procedure was found to be safe. No fatal outcome has been reported.
This study takes about stem cell mobilization from the bone marrow into the blood. This is the first part of the immunosuppression.
Apheresis (ἀφαίρεσις (aphairesis, “a taking away”)) is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation.
Other agents are then used to deplete the immune system such as ant-T cell treatments.