Sustained remission in multiple sclerosis after hematopoietic stem cell transplantation

@article{Tolf2019SustainedRI,
  title={Sustained remission in multiple sclerosis after hematopoietic stem cell transplantation},
  author={Andreas Tolf and Jan Fagius and Kristina Carlson and Torbj{\"o}rn {\AA}kerfeldt and Tobias Granberg and Elna-Marie Larsson and Joachim Burman},
  journal={Acta Neurologica Scandinavica},
  year={2019},
  volume={140},
  pages={320 - 327}
}
To determine whether treatment with autologous hematopoietic stem cell transplantation (HSCT) can induce sustained complete remission in patients with multiple sclerosis (MS). 
Autologous hematopoietic stem cell transplantation for multiple sclerosis: A current perspective
TLDR
There is still debate as to which A HSCT conditioning regimen offers the best balance of long-term efficacy and safety, and new studies comparing AHSCT with highly effective disease-modifying therapies will help to inform on the ideal placement of AHS CT in the treatment algorithm.
Autologous Hematopoietic Stem Cell Transplantation in Multiple Sclerosis Patients: Monocentric Case Series and Systematic Review of the Literature
TLDR
It is demonstrated that AHSCT is a highly efficacious and relatively safe therapeutic option for the treatment of highly active MS, with significant improvements in the development of patient selection criteria, choice of the most suitable transplant technique and clinical experience.
Haematopoietic Stem Cell Transplantation for Multiple Sclerosis: Current Status
TLDR
Higher efficacy of AHSCT than with conventional treatments has recently been demonstrated by one randomised trial and further evidence is awaited from ongoing and planned trials comparing AHS CT with the most effective disease-modifying therapeutic agents.
Immune Reconstitution Following Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis: A Review on Behalf of the EBMT Autoimmune Diseases Working Party
TLDR
Investigating the reconstitution of B cell compartment and stem and effector subsets of immunological memory following autologous HSCT could elucidate the mechanisms that underlie treatment efficacy and ensure that vaccination in subjects undergoing HSCT is effective and safe.
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): An Evolving Treatment Avenue in Multiple Sclerosis
TLDR
Different clinical and molecular aspects of AHSCT application in the alleviation of MS symptoms are discussed and a low density conditioning regimen could be suggested as a suitable candidate approach in the management of MS.
Autologous Hematopoietic Stem-Cell Transplantation in Multiple Sclerosis: A Systematic Review and Meta-Analysis
TLDR
The meta-analysis showed that 68% of patients with MS experience no evidence of disease activity (NEDA) after AHSCT, and with increasing knowledge and expertise in the field of stem-cell therapy, AHS CT has become a safer treatment approach for MS.
Effect of autologous hematopoietic stem cell transplantation on multiple sclerosis and neuromyelitis optica spectrum disorder: a PRISMA-compliant meta-analysis
TLDR
The study supported that AHSCT showed long-term effect on MS and NMOSD patients with a high safety, and low- and intermediate-intensity regimens and RRMS patients showed optimal benefit from AHS CT.
Immunosuppressive Therapy After Autologous Hematopoietic Stem Cell Transplantation in Systemic Sclerosis Patients—High Efficacy of Rituximab
TLDR
Disease progression and secondary autoimmune diseases may necessitate IS after aHSCT in SSc, and rituximab seems to be an efficacious treatment option in this setting.
ANTI-CD20 THERAPY IN MULTIPLE SCLEROSIS-CLINICAL AND PARACLINICAL OUTCOMES
TLDR
The results add to a growing body of evidence suggesting equal or better effectiveness and tolerability of rituximab compared to commonly used drugs in relapsing-remitting multiple sclerosis.
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References

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Autologous hematopoietic stem cell transplantation in multiple sclerosis: A meta-analysis
TLDR
In the article “Autologous hematopoietic stem cell transplantation in multiple sclerosis: Why it is important to select patients suitable for this type of treatment,” a single single cell transplant is recommended for patients with multiple sclerosis.
Brain atrophy after immunoablation and stem cell transplantation in multiple sclerosis
TLDR
The authors measured brain atrophy in nine patients undergoing immunoablation and autologous hematopoietic stem cell transplantation for multiple sclerosis and found that atrophy was 10 times faster than before treatment.
Peripheral blood stem cell transplantation in the treatment of progressive multiple sclerosis: first results of a pilot study
TLDR
Autologous HSCT appears feasible in MS; it does not aggravate disability and seems to offer a clinical benefit, however, these observations need confirmation and long-term outcomes will show if benefits counterbalance toxicity and cost.
Autologous hematopoietic stem cell transplantation in multiple sclerosis
TLDR
The emerging evidence on immunoablative therapy followed by autologous hematopoietic stem cell transplantation to manage severe and treatment-refractory multiple sclerosis indicates that the largest benefit/risk profile form this therapeutic approach can be obtained in patients with aggressive MS with a relapsing-remitting course and who have not yet accumulated a high level of disability.
Long-term Outcomes After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis
TLDR
In this observational study of patients with MS treated with AHSCT, almost half of them remained free from neurological progression for 5 years after transplant, supporting the rationale for further randomized clinical trials of AHS CT for the treatment of MS.
Autologous haematopoietic stem cell transplantation for treatment of multiple sclerosis
TLDR
Evidence indicates that the patients who are most likely to benefit from and tolerate AHSCT are young, ambulatory and have inflammatory MS activity, and clinical trials are required to rigorously test the efficacy, safety and cost-effectiveness of A HSCT against highly active MS drugs.
Thymic output generates a new and diverse TCR repertoire after autologous stem cell transplantation in multiple sclerosis patients
TLDR
These data are the first to demonstrate that long-term suppression of inflammatory activity in MS patients who received HSCT does not depend on persisting lymphopenia and is associated with profound qualitative immunological changes that demonstrate a de novo regeneration of the T cell compartment.
Autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: the Swedish experience
TLDR
HSCT is a very effective treatment of inflammatory active MS and can be performed with a high degree of safety at experienced centres, and presence of gadolinium-enhancing lesions prior to HSCT was associated with a favourable outcome.
Stem cell transplantation in multiple sclerosis: multiple choices and multiple challengesy
TLDR
There is ample evidence that HSCT is a technically feasible approach in MS, not more dangerous than in the hemato-oncological diseases, and therefore overenthusiastic expectations should be tempered.
Autologous haematopoietic stem cell transplantation for neurological diseases
TLDR
Available data suggest that autologous haematopoietic stem cell transplantation is superior to conventional treatment in terms of efficacy with an acceptable safety profile.
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