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Would Autologous Stem Cell Transplant be beneficial?

Messages
4
I have tried to find information about whether autologous stem cell transplant could be beneficial for cfs patients where the immune system is involved. Considering that for instance MS patients have benefited from this, it might be the case for cfs too (if it can be proved that it is in-fact an autoimmune disease of course). I have not found any study or similar, does anyone know of case reports or similar?
 

Daffodil

Senior Member
Messages
5,873
its been done for severe CFS and has had mixed results, i believe.

i would think this might be a very extreme approach
 

Jonathan Edwards

"Gibberish"
Messages
5,256
I have tried to find information about whether autologous stem cell transplant could be beneficial for cfs patients where the immune system is involved. Considering that for instance MS patients have benefited from this, it might be the case for cfs too (if it can be proved that it is in-fact an autoimmune disease of course). I have not found any study or similar, does anyone know of case reports or similar?

It is worth remembering that autologous stem cell transplantation is not actually a treatment. It is just how you keep people alive after giving them lethal doses of cytotoxic therapy. So the question is is it worth treating ME with potentially lethal doses of cytotoxics.

In cancer cytotoxics are given to kill the cancer cells and killing all your immune cells is just an unfortunate side effect. I think if we want to kill immune cells deliberately it is more sensible to use drugs that pick off these cells specifically. We can get rid of most B cells with rituximab. We can get rid of most T cells with Campath1H. What we are less good at is getting rid of plasma cells but to do that you really do seem to need very toxic amounts of conventional drugs (e.g. cyclophosphamide) and even then the effect is very partial. In other words the added advantage of nuclear blasting with drugs that need stem cell rescue looks pretty marginal on theoretical grounds.

Interestingly, Campath1H is very good at getting rid of T cells but doctors are rather hesitant to use it for immune diseases, despite the fact that patients who have had it seem to manage without T cells for ages without many problems. Maybe some people with ME should be given Campath1H.
 
Messages
4
It is worth remembering that autologous stem cell transplantation is not actually a treatment. It is just how you keep people alive after giving them lethal doses of cytotoxic therapy. So the question is is it worth treating ME with potentially lethal doses of cytotoxics.

In cancer cytotoxics are given to kill the cancer cells and killing all your immune cells is just an unfortunate side effect. I think if we want to kill immune cells deliberately it is more sensible to use drugs that pick off these cells specifically. We can get rid of most B cells with rituximab. We can get rid of most T cells with Campath1H. What we are less good at is getting rid of plasma cells but to do that you really do seem to need very toxic amounts of conventional drugs (e.g. cyclophosphamide) and even then the effect is very partial. In other words the added advantage of nuclear blasting with drugs that need stem cell rescue looks pretty marginal on theoretical grounds.

Interestingly, Campath1H is very good at getting rid of T cells but doctors are rather hesitant to use it for immune diseases, despite the fact that patients who have had it seem to manage without T cells for ages without many problems. Maybe some people with ME should be given Campath1H.

Would not ASCT kill all present immune cells and not just e.g. cells expressing CD20 (that rituxan gets rid of) being a more complete/different way to reset the immune system?. I am aware of that this "treatment" (in lack of a better word) might be infeasible. However, there seems to be quite a few papers reporting on good outcome in diseases such as MS, systemic sclerosis etc, which might indicate(?) that the same could be the case for certain groups of CFS patients.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Would not ASCT kill all present immune cells and not just e.g. cells expressing CD20 (that rituxan gets rid of) being a more complete/different way to reset the immune system?. I am aware of that this "treatment" (in lack of a better word) might be infeasible. However, there seems to be quite a few papers reporting on good outcome in diseases such as MS, systemic sclerosis etc, which might indicate(?) that the same could be the case for certain groups of CFS patients.

The only other immune cells you are likely to want to kill to reset the system are T cells and Campath1H kills those without any of the toxicity of traditional chemotherapy. The results with ASCT for the diseases you mention are probably about as good as for rituximab and rituximab is much gentler and safer.
 
Messages
4
Thanks for your response.
However, there is one thing I don't fully understand; I regularly read in the (norwegian) news about MS sufferers having used different halting medicines for years, then tries ASCT and go into remission with no more need for immune therapy. Isn't there something else happening with the immune system with this approach, that regular immune therapy can not achieve?
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Thanks for your response.
However, there is one thing I don't fully understand; I regularly read in the (norwegian) news about MS sufferers having used different halting medicines for years, then tries ASCT and go into remission with no more need for immune therapy. Isn't there something else happening with the immune system with this approach, that regular immune therapy can not achieve?

You have to remember that MS is an episodic disease and after any one episode there is no way of knowing whether you will ever have another. So a significant minority of people with MS 'go into remission and have no more need for immune therapy' all the time with no treatment. This is why it is a particularly difficult disease to assess drugs for.

The other thing is that the lethal chemotherapy given prior to ASCR (R stands for rescue, which is the true role) will put almost any autoimmune disease into remission for about 2-5 years. But a small number of people die - it used to be one in twenty, now it is much less. So if we are looking for a remission of up to five years ASCR will do it for a few more than would have been well anyway. A single course of rituximab will do it for a few.

And in a sense this IS 'regular immune therapy' just a lethal dose - mostly cyclophosphamide which is the oldest immune therapy in the book. People get excited by the idea of 'stem cells' but as indicated, these are not the therapy, just the way to stay alive. It is a very old fashioned and crude technique in comparison to what we have now.
 

Jonathan Edwards

"Gibberish"
Messages
5,256
Ah, thought the remission after ASCT/R lasted throughout life, this was really clarifying.

In some cases it may, but then a proportion of people with MS stop getting episodes (go into remission) for life anyway. The fashion for ASCR grew up around 1995 and most of the results were presented on two to five year follow up. I don't know if there have been longer term reports but my colleague in Switzerland who was heavily involved in this ended up concluding that there was little evidence of permanent effect in most autoimmune diseases studies.
 

Kati

Patient in training
Messages
5,497
I worked in a bone marrow/stem cell transplant unit for a few years. It is not a fun procedure for patients. You need to know that the chemo will destroy all fast reproducing cells. Blood cells are one of them. It means you will likely need blood and platelet transfusions after the chemo.

Most people will have neutropenic fever. It means that the immune system will not be able to fight infections and that left untreated these would be deadly. So you will receive a cocktail of 3 antibiotics, usually the biggest hitters, to cover all basis, along with antifungals.

Then the chemo also kills the gut cells since they are too fast reproducing. All mucosa cells in fact, which means your mouth will become raw, all lining of the mouth would slough off, and this would also apply to all the gut cells all the way to the other end. Pain, and horrible diarrhea would definitely occur, not just one day, usually couple of weeks until your stem cells reach the marrow and start making new cells again.

While the mortality rate has decreased for this procedure, it is still a risky intervention and in general patients have no clue how hard it gets.