Members log in

Remember me

Do not refresh my screen on timeout

close

News

ABN Neurology for Medical Students Event: Call for abstracts - deadline 24 September 2018.

Read More

Events

ABN/SBNS Joint meeting 19 - 21 September 2018

Read More

ABN statement on autologous haematopoietic stem cell treatment of multiple sclerosis

The Association of British Neurologists welcomes recent research into autologous haematopoietic stem cell treatment of multiple sclerosis. Despite many advances in the treatment of this disease, for some people it is disabling and life-limiting. New therapies which combine high efficacy with acceptable side-effects are certainly needed. However, as a recent commentary put it “the jury is still out regarding the appropriateness and indications of haematopoietic stem cell treatment for multiple sclerosis” (Soldán & Weinshenker, 2015).

 

Autologous haematopoietic stem cell treatment should only be seen as a potential immunotherapy in multiple sclerosis; there is no suggestion that these stem cells are reparative. Therefore there is no rationale for its use in people with progressive multiple sclerosis. As the experience from Sheffield shows, some people with relapsing-remitting multiple sclerosis anecdotally report considerable benefit from autologous haematopoietic stem cell treatment. Similar successes with this treatment have been reported from many small open-label studies since the early 1990s, but these are not powered to identify a true clinical benefit (Snowden 2012). However, there is a treatment-associated mortality. This has decreased from 6% to approximately 1.5%, probably because of the reduced intensity of contemporary immunoablation regimens (some of which include alemtuzumab, itself a licensed treatment of multiple sclerosis). The only controlled trial to date, the small (n=21) Autologous Stem cell Transplantation International MS Trial, demonstrated that transplantation was more effective at reducing new MRI lesions than mitoxantrone (Mancardi 2015). But larger controlled studies are needed to explore the optimum transplant conditioning regime, and its relative efficacy and safety compared to other licensed therapies. Professor Sharrack and others are participating in one such trial (ClinicalTrials.gov Identifier: NCT00273364).

 

We would encourage neurologists to support controlled trials of autologous haematopoietic stem in established transplant centres. At present, it does not have a place in the routine treatment of multiple sclerosis (see ABN Guidelines ). 

Paz Soldán MM, Weinshenker BG. Moving targets for hematopoietic stem cell transplantation for multiple sclerosis. JAMA Neurol. 2015 Feb;72(2):147-9. doi: 10.1001/jamaneurol.2014.3831. PubMed PMID: 25546257.

Snowden JA, Saccardi R, Allez M, Ardizzone S, Arnold R, Cervera R, Denton C, Hawkey C, Labopin M, Mancardi G, Martin R, Moore JJ, Passweg J, Peters C, Rabusin M, Rovira M, van Laar JM, Farge D; EBMT Autoimmune Disease Working Party (ADWP); Paediatric Diseases Working Party (PDWP). Haematopoietic SCT in severe autoimmune diseases: updated guidelines of the European Group for Blood and Marrow Transplantation. Bone Marrow Transplant. 2012 Jun;47(6):770-90. doi: 10.1038/bmt.2011.185. Epub 2011 Oct 17. PubMed PMID: 22002489; PubMed Central PMCID: PMC3371413.

Mancardi GL, Sormani MP, Gualandi F, Saiz A, Carreras E, Merelli E, Donelli A, Lugaresi A, Di Bartolomeo P, Rottoli MR, Rambaldi A, Amato MP, Massacesi L, Di Gioia M, Vuolo L, Currò D, Roccatagliata L, Filippi M, Aguglia U, Iacopino P, Farge D, Saccardi R; ASTIMS Haemato-Neurological Collaborative Group, On behalf of the Autoimmune Disease Working Party (ADWP) of the European Group for Blood and Marrow Transplantation (EBMT); ASTIMS Haemato-Neurological Collaborative Group On behalf of the Autoimmune Disease Working Party ADWP of the European Group for Blood and Marrow Transplantation EBMT. Autologous hematopoietic stem cell transplantation in multiple sclerosis: a phase II trial. Neurology. 2015 Mar 10;84(10):981-8. doi: 212/WNL.0000000000001329. Epub 2015 Feb 11. PubMed PMID: 25672923.

 

 

 

 

Click here for the full document

News

ABN Neurology for Medical Students Event: Call for abstracts - deadline 24 September 2018.

Read More

Events

ABN/SBNS Joint meeting 19 - 21 September 2018

Read More