A study published online December 21, 2022 found that in patients with active secondary progressive multiple sclerosis (MS), hematopoietic stem cell transplantation caused more disability than some other MS treatments. may be delayed. neurology®, the medical journal of the American Academy of Neurology. The study involved autologous hematopoietic stem cell transplantation, which uses healthy blood stem cells from one’s own body to replace diseased cells.
Most MS patients are initially diagnosed with relapsing-remitting MS, which is characterized by flares of symptoms followed by periods of remission, but many people with relapsing-remitting MS eventually progress to secondary progressive MS. . A slow and steady exacerbation of the disease.
“Although hematopoietic stem cell transplantation was previously found to delay disability in patients with relapsing-remitting MS, less is known about whether such transplantation would help delay disability in the more advanced stages of the disease. It’s not done,” said study author Matilde Inglese, MD. She received her PhD from the University of Genoa, Italy and is also a member of the American Academy of Neurology. “Current treatments for secondary progressive multiple sclerosis have only modest benefits, but stem cell transplantation not only delays disability more than many other multiple sclerosis treatments, but also modestly improves symptoms. Our results are encouraging, as we found that
This retrospective study included 79 people with active secondary progressive MS who underwent stem cell transplantation and 1,975 people from an Italian MS registry who were treated with MS medications. All were treated after being diagnosed with active secondary progressive MS. The two groups were matched for age, sex and level of disability. Drugs included beta-interferon, azathioprine, glatiramer acetate, mitoxantrone, fingolimod, natalizumab, methotrexate, teriflunomide, cyclophosphamide, dimethyl fumarate, and alemtuzumab.
Participants’ impairment levels were measured on the Extended Disability Status Scale. The Extended Disability Status Scale is a common way to quantify disability, with scores ranging from 0, no symptoms, 10 points, to death from MS. Participants were evaluated at various time points over a 10-year period.
The median participant score at study entry was 6.5 for both transplanted and medicated patients. A score of 6.0 is defined as requiring approximately 100 meters with or without rest, intermittently, or using a cane or brace on one side. A score of 6.5 is defined as the need to use a cane or brace on both sides at all times to walk approximately 20 meters without rest.
Five years into the study, researchers found that 62% of those who received stem cell transplants experienced no worsening of their MS impairment compared to 46% of those who took the drug.
The researchers also found that people who underwent stem cell transplants were more likely to see lasting improvement five years later, with 19% having fewer disabilities than they had at the start of the study. Only 4% of people were taking it.
Over a 10-year period, disability scores decreased by an average of 0.01 points per year for those who received stem cell transplants, indicating less disability, whereas average scores increased by 0.16 points per year for those on medication, indicating more disability. indicates that you have
“Our study shows that hematopoietic stem cell transplantation slows the progression of disability and is likely to improve disability compared to other treatments,” Inglese said. “While these results are encouraging, they do not apply to patients with secondary progressive MS who do not have signs of inflammatory disease activity. I need to do research.”
A limitation of this study is that it is retrospective and observational and does not prove cause and effect. The study also did not include people taking the multiple sclerosis drugs siponimod, cladribine, ocrelizumab, ofatumumab, or rituximab.
This study was funded by the Italian Multiple Sclerosis Foundation.
