HSCT Chicago style

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I dont need to say anything here. HSCT chicago style is not where the HSCT replaces the immune system it is there to stop infection as the existing immune system recovers. Therefore it is immunosuppression plus. As you can see the results for relapsing MS is pretty impressive. The study to do a head-head trial has started with the first people enrolled in Sheffield in a trial called MS-STAR. This trial is different as it an ablatie study replacing the immune system However, as is evident people with relapsing MS respond better than people with progressive MS. However you will note that the infection and procedural death rate is low,.

Burt RK, Han X, Quigley K, Helenowski IB, Balabanov R. Real-world application of autologous hematopoietic stem cell transplantation in 507 patients with multiple sclerosis. J Neurol. 2021 Oct 11:1–14.

Objective: To investigate the results of real-world application of non-myeloablative autologous HSCT for multiple sclerosis (MS).

Methods: Between July 2003 and October 2019 at a single center (Northwestern University), 414 patients with relapsing remitting MS (RRMS) and 93 patients with newly diagnosed secondary progressive MS (SPMS) underwent non-myeloablative HSCT.

Results: There was one treatment-related death (0.19%) due to hospital-acquired legionella pneumonia, and one patient developed neutropenic bacteremia (Klebsiella pneumonia) without sepsis. Overall 5-year survival was 98.8%. Post HSCT secondary autoimmune diseases (2nd ADs) were idiopathic thrombocytopenia (ITP) and hypo or hyperthyroidism. ITP was highest with alemtuzumab (14%) and 0 to 2.8% for the non-alemtuzumab regimens. After HSCT, 16 patients developed hypothyroidism (3.5%) and 15 developed hyperthyroidism / Grave’s disease (3.3%). Relapse free survival (RFS) at 5 years for RRMS and SPMS was 80.1% and 98.1%, respectively, while progression free survival (PFS) at 4 years for RRMS and SPMS was 95% versus 66%, respectively. For patients with RRMS, the EDSS significantly improved (p < 0.0001) at each follow-up from a pre-HSCT mean of 3.87 to 2.51, 2.50, 2.41, 2.33, and 2.19 at 1, 2, 3, 4, and 5 years, respectively. For SPMS, the EDSS improved significantly only at 1 year but not thereafter. For SPMS, the mean baseline EDSS of 5.09 changed post-HSCT to 4.85 (p = 0.04), 4.88 (p = 0.2), 4.92 (p = .27), 4.72 (p = 0.07), and 4.2 (p = 0.21) at 1, 2, 3, 4, 5 years, respectively.

Conclusion: In patients with RRMS, autologous non-myeloablative HSCT is an effective one-time therapy, while HSCT appears of less benefit for newly diagnosed SPMS.

General Disclaimer: Please note that the opinions expressed here are those of the author and do not necessarily reflect the positions of the Barts and The London School of Medicine and Dentistry nor Barts Health NHS Trust and are not meant to be interpreted as personal clinical advice.

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MouseDoctor

4 comments

  • When I was single, no doubt I would take HSCT when offered.

    But now, having a lovely lady next to me, I think I’m a little bit scared for HSCT!

    • I mean, would you reject a hip replacement if you were offered one? Because the mortality rate is pretty much the same.

      • We estimate the pooled incidence of mortality during the first 30 and 90 days following hip replacement to be 0.30% (95% CI 0.22 to 0.38) and 0.65% (95% CI 0.50 to 0.81), respectively…Rate of COVID-vaccine related death is much lower people still dont want it:-)

  • Well that’s pretty cool, as a regular reader in the USA I didn’t expect to see my doctor (R. Balabanov) cited on this site. 🙂

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