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Stem Cell Transplants May Treat Aggressive MS

Study Shows Improvements in MS Patients Who Replace Bone Marrow With Stem Cells

Best Candidates for Stem Cell Transplants

Stem cells have long been used to treat cancer patients, but they are still considered experimental in autoimmune diseases like multiple sclerosis.

But many believe they offer great hope.

“It’s the only therapy to date that has been shown to reverse neurologic deficits,” says Richard K. Burt, MD, chief of the division of medicine-immunotherapy for autoimmune diseases at Northwestern University’s Feinberg School of Medicine in Chicago. “But you have to get the right group of patients.”

In Burt’s study, which was published in The Lancet in 2009, 17 out of 21 patients with relapsing-remitting MS improved after stem cell transplants, and none had gotten worse after an average of three years.

As a follow-up to that study, Burt and collaborators in Brazil and Sweden are recruiting patients for a study comparing stem cell transplants to Tysabri, a biologic drug, for the treatment of multiple sclerosis.  He is not involved in the current research.

“You have to do it earlier in the disease, that’s where the excitement is, and that’s why we’re doing the randomized trial,” Burt says.

Another article, published in the February issue of Multiple Sclerosis Journal, shows that steps taken before the stem cells are transplanted back into the body may have an effect on how well the procedure works.

Before the stem cells can be reintroduced, patients go through a conditioning process with chemotherapy, either alone or in combination with radiation, in an attempt to wipe out their dysfunctional immune systems. That’s called a high-intensity conditioning regimen.

But a different kind of conditioning, called intermediate-intensity or ”mini” stem cell transplantation, doesn’t try to kill off all of the errant immune system.

“There was a tendency for there to be longer progressive-free survival in the studies that used the intermediate-intensity regimens compared to those that used the high-intensity regimens,” says James T. Reston, PhD, MPH, a research analyst in the Evidence-Based Practice Center at the ECRI Institute in Plymouth Meeting, Pa., an independent, nonprofit group that reviews evidence for experimental therapies.

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