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Chemotherapy and stem cell treatment successful in MS

Bob

Senior Member
Messages
16,455
Location
England (south coast)
There are a heap of articles published about this today...

This is the research paper...

Immunoablation and autologous haemopoietic stem-cell transplantation for aggressive multiple sclerosis: a multicentre single-group phase 2 trial
Atkins HL et al.
2016
The Lancet.
DOI: http://dx.doi.org/10.1016/S0140-6736(16)30169-6
Summary
Background
Strong immunosuppression, including chemotherapy and immune-depleting antibodies followed by autologous haemopoietic stem-cell transplantation (aHSCT), has been used to treat patients with multiple sclerosis, improving control of relapsing disease. We addressed whether near-complete immunoablation followed by immune cell depleted aHSCT would result in long-term control of multiple sclerosis.

Methods
We did this phase 2 single-arm trial at three hospitals in Canada. We enrolled patients with multiple sclerosis, aged 18–50 years with poor prognosis, ongoing disease activity, and an Expanded Disability Status Scale of 3·0–6·0. Autologous CD34 selected haemopoietic stem-cell grafts were collected after mobilisation with cyclophosphamide and filgrastim. Immunoablation with busulfan, cyclophosphamide, and rabbit anti-thymocyte globulin was followed by aHSCT. The primary outcome was multiple sclerosis activity-free survival (events were clinical relapse, appearance of a new or Gd-enhancing lesion on MRI, and sustained progression of Expanded Disability Status Scale score). This study was registered at ClinicalTrials.gov, NCT01099930.

Findings
Between diagnosis and aHSCT, 24 patients had 167 clinical relapses over 140 patient-years with 188 Gd-enhancing lesions on 48 pre-aHSCT MRI scans. Median follow-up was 6·7 years (range 3·9–12·7). The primary outcome, multiple sclerosis activity-free survival at 3 years after transplantation was 69·6% (95% CI 46·6–84·2). With up to 13 years of follow-up after aHSCT, no relapses occurred and no Gd enhancing lesions or new T2 lesions were seen on 314 MRI sequential scans. The rate of brain atrophy decreased to that expected for healthy controls. One of 24 patients died of transplantation-related complications. 35% of patients had a sustained improvement in their Expanded Disability Status Scale score.

Interpretation
We describe the first treatment to fully halt all detectable CNS inflammatory activity in patients with multiple sclerosis for a prolonged period in the absence of any ongoing disease-modifying drugs. Furthermore, many of the patients had substantial recovery of neurological function despite their disease's aggressive nature.

Funding
Multiple Sclerosis Scientific Research Foundation.
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
We describe the first treatment to fully halt all detectable CNS inflammatory activity in patients with multiple sclerosis for a prolonged period in the absence of any ongoing disease-modifying drugs.
They keep publishing similar studies but the "prolonged period" may not be forever. My friend had this procedure and the prolonged period was 5 years....then he began regressing.
 

Justin30

Senior Member
Messages
1,065
I see think like cancer people will go into remission but can get it back......hopefully this works and becomes a viable option.

I honestly think this will be a solution to Neuro ME patients at some point or the portion that Responds to Rituximab......

I would honestly like to see mixed immune therapy followed by stem cells in this disease. Some of the new stem cells being developed can switch on and off genes...pretty amazing....
 

Marky90

Science breeds knowledge, opinion breeds ignorance
Messages
1,253
This will/should be, the last option, for relapsing ME-patients who have responded to immunosuppressive agents - in the future.
 

Justin30

Senior Member
Messages
1,065
This will/should be, the last option, for relapsing ME-patients who have responded to immunosuppressive agents - in the future.

What about those with progressive ME for which no treatment works?

For the severe I almost think that a boost with stem cells followed by a complete immune system wipe out then rebuild it again with clean stem cells. With all the talk coming out of the lastest conference it seems like ME is looking more autoimmune for the a greater # of people.

We barely have effective treatments for AI diseases that currently exist.
 

Marky90

Science breeds knowledge, opinion breeds ignorance
Messages
1,253
What about those with progressive ME for which no treatment works?

For the severe I almost think that a boost with stem cells followed by a complete immune system wipe out then rebuild it again with clean stem cells. With all the talk coming out of the lastest conference it seems like ME is looking more autoimmune for the a greater # of people.

We barely have effective treatments for AI diseases that currently exist.

Well one would need stronger indications for ME being possibly AI, than we have now. In sclerodermia clinical trials on SCT are ongoing, even though the underlying disease process is not completely understood. They do however know much more than we do with ME.
 

Justin30

Senior Member
Messages
1,065
Well one would need stronger indications for ME being possibly AI, than we have now. In sclerodermia clinical trials on SCT are ongoing, even though the underlying disease process is not completely understood. They do however know much more than we do with ME.

I agree...that being said many of those whos rituximab has been succeful for have had autoantibodies which I assume are autoimmune type antibodies. These individuals show ANA, Muscarinic, Acetylcholine, and other autoantibodies.

What I have heard that stem cells can get a person with ME well enough to potentially with stand a treatment that wipes out their immune system.

These are all just thoughts. I dont know if you have seen the article below:

http://www.healthrising.org/blog/20...-progress-invest-me-chronic-fatigue-syndrome/
 

Marky90

Science breeds knowledge, opinion breeds ignorance
Messages
1,253
I agree...that being said many of those whos rituximab has been succeful for have had autoantibodies which I assume are autoimmune type antibodies. These individuals show ANA, Muscarinic, Acetylcholine, and other autoantibodies.

What I have heard that stem cells can get a person with ME well enough to potentially with stand a treatment that wipes out their immune system.

These are all just thoughts. I dont know if you have seen the article below:

http://www.healthrising.org/blog/20...-progress-invest-me-chronic-fatigue-syndrome/

We are talking about the same thing, or? Stem cell transplant, not stem cell injection?
 

justy

Donate Advocate Demonstrate
Messages
5,524
Location
U.K
We are talking about the same thing, or? Stem cell transplant, not stem cell injection?
YES - this is important. Lots of discussions on Lyme groups too about the usefulness of stem cells, and then people pointing to the MS research. The MS research is a stem cell transplant - a very risky and dangerous procedure. A friend of mine had it for aggressive rare cancer and it was a very big deal. She survived but now, post treatment has severe fatigue and may never be as well as she was pre cancer treatment.

The type of stem cell treatment being talked about for Lyme etc is a stem cell injection - not a transplant (autologous or otherwise)
 

Marky90

Science breeds knowledge, opinion breeds ignorance
Messages
1,253
YES - this is important. Lots of discussions on Lyme groups too about the usefulness of stem cells, and then people pointing to the MS research. The MS research is a stem cell transplant - a very risky and dangerous procedure. A friend of mine had it for aggressive rare cancer and it was a very big deal. She survived but now, post treatment has severe fatigue and may never be as well as she was pre cancer treatment.

The type of stem cell treatment being talked about for Lyme etc is a stem cell injection - not a transplant (autologous or otherwise)

Exactly. Patients with different types of marrow failure, typically also experience a range of very unpleasant side effects. Graft versus host disease etc. The field of BMT is however progressing rapidly, and will probably be a lot less dangerous in 10 years.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Thought this would be of interest here. Looks like a more thorough version of what Fluge and Mella are attempting with rituximab. Any idea if anyone can be persuaded to do a trial of this for M.E patients?

http://www.ohri.ca/newsroom/newsstory.asp?ID=786

I think we already have a thread on this. I would not consider it for ME/CFS. This approach has been going for some twenty years and although it works people die (one in this study) from the treatment - about 4% in the past, maybe a bit less now. Busulphan and cyclophosphamide is a horrible cocktail to tolerate. Until we have some idea which bit of the immune system might need ablating in which patients it cannot be justified, as I see it. In the diseases where both have been tried (rituximab and high dose ablation with stem cell rescue), which is RA, MS, lupus and a few more, the results with the two treatments are not very different. Rituximab stops new episodes in MS completely, like this. It has not been developed for what look to me like commercial reasons. I strongly suspect that killing anything more than B cells is not needed. Rituximab may need repeating but at least that is easy enough. If relapse occurs after ablation with rescue repeating is probably not an option.
 

veganmua

Senior Member
Messages
145
Location
London, UK
I think we already have a thread on this. I would not consider it for ME/CFS. This approach has been going for some twenty years and although it works people die (one in this study) from the treatment - about 4% in the past, maybe a bit less now. Busulphan and cyclophosphamide is a horrible cocktail to tolerate. Until we have some idea which bit of the immune system might need ablating in which patients it cannot be justified, as I see it. In the diseases where both have been tried (rituximab and high dose ablation with stem cell rescue), which is RA, MS, lupus and a few more, the results with the two treatments are not very different. Rituximab stops new episodes in MS completely, like this. It has not been developed for what look to me like commercial reasons. I strongly suspect that killing anything more than B cells is not needed. Rituximab may need repeating but at least that is easy enough. If relapse occurs after ablation with rescue repeating is probably not an option.
Thanks for your insight. I did check, but I must've missed the other thread!
 

Justin30

Senior Member
Messages
1,065
Without knowing what ME is...which I personally think is more than one disease....

Using different approaches I feel is the future of ME especially when I feel it is likely different diseases.
 

Sushi

Moderation Resource Albuquerque
Messages
19,935
Location
Albuquerque
They keep publishing similar studies but the "prolonged period" may not be forever. My friend had this procedure and the prolonged period was 5 years....then he began regressing.
Quote from my friend who had this procedure:
...the researchers behind HALT-MS, the stem cell transplant study I participated in, released their 5-year data and it is powerful: nearly 70% have had zero disease activity. Good to be a part of such ground-breaking research, even if I'm in the 30% (meh, that's life).