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Pastelín-Martínez MDL, Gallardo-Pérez MM, Gómez-de-León A, Olivares-Gazca JC, Hernández-Flores EJ, Sánchez-Bonilla D, Montes-Robles M, Robles-Nasta M, Ocaña-Ramm G, Soto-Olvera S, Gómez-Almaguer D, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. The consequences of delayed diagnosis and treatment in persons with multiple sclerosis given autologous hematopoietic stem cell transplantation. Diagnosis (Berl) 2024; 11:164-170. [PMID: 38230519 DOI: 10.1515/dx-2023-0157] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 01/02/2024] [Indexed: 01/18/2024]
Abstract
OBJECTIVES We have analyzed the association of delayed both diagnosis and treatment of persons with MS with the long-term results of patients given autologous hematopoietic stem cell transplantation (aHSCT). METHODS Patients with MS referred to the HSCT-Mexico program were included in the study; in 103, detailed pre- and post-transplant evolution could be recorded. Two groups of patients were analyzed according to the time of evolution between the onset of symptoms and the definite diagnosis of MS: more than 8 months (delayed diagnosis, DD), or less than 8 months (non-delayed diagnosis, NDD). The progression of MS was assessed by changes in the expanded disability status scale (EDSS). RESULTS The time elapsed between the onset of symptoms and the correct diagnosis was lower for the NDD group (1.55 vs. 35.87 months, p<0.05). Both groups of patients showed a similar EDSS score at diagnosis (1.5 vs. 1.5); however, the EDSS at the time of the transplant was higher in the DD group (4.5 vs. 3.0, p=0.3) and the response of the EDSS score to the transplant was significantly better for the NDD group, the last EDSS scores being 2.5 vs. 4.25 (p=0.03). Both groups of patients responded to aHSCT by diminishing the EDSS, but the response was significantly better in the NDD group. CONCLUSIONS These data indicate that both the pre-transplant progression of the disease and the response to aHSCT were significantly worse in the DD group. An early diagnosis and an early aHSCT intervention are critical for a good prognosis, in terms of lowering and stabilizing the motor disability in MS patients given autografts.
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Affiliation(s)
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | | | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Edgar Jared Hernández-Flores
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Merittzel Montes-Robles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Anáhuac de Puebla, Puebla, México
| | - Max Robles-Nasta
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Guillermo Ocaña-Ramm
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Silvia Soto-Olvera
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
- Laboratorios RUIZ, SYNLAB, Puebla, México
| | | | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, México
- Universidad Popular Autónoma del Estado de Puebla, Puebla, México
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2
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Gakis G, Angelopoulos I, Panagoulias I, Mouzaki A. Current knowledge on multiple sclerosis pathophysiology, disability progression assessment and treatment options, and the role of autologous hematopoietic stem cell transplantation. Autoimmun Rev 2024; 23:103480. [PMID: 38008300 DOI: 10.1016/j.autrev.2023.103480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Accepted: 11/20/2023] [Indexed: 11/28/2023]
Abstract
Multiple sclerosis (MS) is an autoimmune disease of the central nervous system (CNS) that affects nearly 2.8 million people each year. MS distinguishes three main types: relapsing-remitting MS (RRMS), secondary progressive MS (SPMS) and primary progressive MS (PPMS). RRMS is the most common type, with the majority of patients eventually progressing to SPMS, in which neurological development is constant, whereas PPMS is characterized by a progressive course from disease onset. New or additional insights into the role of effector and regulatory cells of the immune and CNS systems, Epstein-Barr virus (EBV) infection, and the microbiome in the pathophysiology of MS have emerged, which may lead to the development of more targeted therapies that can halt or reverse neurodegeneration. Depending on the type and severity of the disease, various disease-modifying therapies (DMTs) are currently used for RRMS/SPMS and PPMS. As a last resort, and especially in highly active RRMS that does not respond to DMTs, autologous hematopoietic stem cell transplantation (AHSCT) is performed and has shown good results in reducing neuroinflammation. Nevertheless, the question of its potential role in preventing disability progression remains open. The aim of this review is to provide a comprehensive update on MS pathophysiology, assessment of MS disability progression and current treatments, and to examine the potential role of AHSCT in preventing disability progression.
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Affiliation(s)
- Georgios Gakis
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Angelopoulos
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Ioannis Panagoulias
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece
| | - Athanasia Mouzaki
- Laboratory of Immunohematology, Medical School, University of Patras, Patras, Greece.
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Sui Z, Zhu H, Luo J, Yu J, Li L, Zheng Q. Quantitative comparison of the efficacy of clinical drug treatments for primary progressive multiple sclerosis. J Clin Neurosci 2023; 113:45-53. [PMID: 37178621 DOI: 10.1016/j.jocn.2023.04.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/25/2023] [Accepted: 04/03/2023] [Indexed: 05/15/2023]
Abstract
OBJECTIVE This study proposes a comprehensive quantitative evaluation of the efficacy of drugs and placebo in clinical trials for primary progressive multiple sclerosis (PPMS). METHODS A literature search was conducted using the PubMed, EMBASE, and Cochrane library databases and the clinical studies reporting drug efficacy in the treatment of PPMS were included in the analyses. The cumulative proportion of patients without confirmed disability progression (wCDP%) was used as the main efficacy endpoint. The model-based meta-analysis method was used to describe the time course of each drug (as well as placebo) in order to rank the drug efficacy for the treatment of PPMS. RESULTS Fifteen studies involving 3779 patients were included, of which, nine were placebo-controlled and six were single-arm trials. Twelve drugs were included in the study. The results showed that, except for biotin, interferon β-1a, and interferon β-1b, whose efficacy was comparable to the placebo, the efficacy of the other 9 drugs were significantly better than placebo. Among these, ocrelizumab showed outstanding performance, with wCDP% of 72.6 at 96 weeks, while the proportions of rest of the drugs ranged between approximately 55-70%. CONCLUSION The results of this study provide the necessary quantitative information for both the rational clinical use of drugs and future clinical trials in primary progressive multiple sclerosis.
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Affiliation(s)
- Zichao Sui
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Haoxiang Zhu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jieren Luo
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Jiesen Yu
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China
| | - Lujin Li
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
| | - Qingshan Zheng
- Center for Drug of Clinical Research, Shanghai University of Traditional Chinese Medicine, Shanghai, China.
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4
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Sánchez-Bonilla D, Robles-Nasta M, Gallardo-Pérez MM, Hernández-Flores EJ, Montes-Robles M, Pastelín-Martínez MDL, Garcés-Eisele SJ, Olivares-Gazca JC, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Long-term results of autografting persons with multiple sclerosis are better in those not exposed to prior disease-modifying therapies. Mult Scler Relat Disord 2023; 75:104744. [PMID: 37178580 DOI: 10.1016/j.msard.2023.104744] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 04/12/2023] [Accepted: 04/30/2023] [Indexed: 05/15/2023]
Abstract
INTRODUCTION Multiple sclerosis (MS) is a disabling disease that affects young adults. Treatments for MS have increased exponentially in number, efficacy and risk. Autologous hematopoietic stem cell transplantation (aHSCT) can change the natural history of the disease. To analyze if aHSCT should be done early in the course of the disease or after failing of other therapies, we have studied the long-term results of aHSCT in a cohort of persons with MS who were given, or not, immunosuppressive drugs before the transplant. MATERIALS AND METHODS Patients with MS referred to our center for aHSCT between June 2015 and January 2023 were prospectively entered in the study. All phenotypes of MS were included (relapsing remitting, primary progressive and secondary progressive). The follow up was assessed with the patient reported EDSS score in an online form; only patients followed by three or more years were included in the analysis. Patients were divided into two groups: Given or not disease modifying treatments (DMT) before the aHSCT. RESULTS 1132 subjects were prospectively enrolled. 74 patients were followed for more than 36 months, and the subsequent analysis was done in this cohort. The response rate (RR = improvement + stabilization) at 12, 24 and 36 mo was 84%, 84% and 58% respectively for patients not receiving prior DMT and 72%, 90% and 67% for patients receiving DMT. In the whole group, the EDSS score dropped from a mean of 5.5 to 4.5 at 12 mo, to 5.0 at 24 mo and to 5.5 at 36 mo, after the aHSCT. The EDSS score was on average worsening in patients before the aHSCT, but the transplant stabilized the EDSS score at 3 years in patients with prior exposure to DMT, whereas in persons not given DMT, the transplant resulted in a significant decrease (p = .01) of the EDSS score. This indicates a positive response in all patients given aHSCT, but significantly better in those not exposed to DMT before the graft. CONCLUSION The response to aHSCT was better for persons not exposed to immunosuppressive DMT before the transplant, thus suggesting that aHSCT should be done early in the course of the disease and probably before the treatment with DMT. Additional studies are needed to further analyze the impact of the use of DMT therapies before the aHSCT in MS, as well as the timing of the procedure.
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Affiliation(s)
- Daniela Sánchez-Bonilla
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Max Robles-Nasta
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Moisés Manuel Gallardo-Pérez
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Edgar J Hernández-Flores
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Merittzel Montes-Robles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Anáhuac Puebla. Puebla, México
| | | | - Solón Javier Garcés-Eisele
- Universidad Popular Autónoma del Estado de Puebla. Puebla, México; Laboratorios Ruiz. Laboratorios SYNLAB Puebla, México
| | - Juan Carlos Olivares-Gazca
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México
| | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna, Clínica Ruiz, Puebla, México; Universidad Popular Autónoma del Estado de Puebla. Puebla, México.
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Ruiz-Argüelles GJ, Seber A, Ruiz-Delgado GJ. Conducting hematopoietic stem cell transplantation in low and middle income countries. HEMATOLOGY (AMSTERDAM, NETHERLANDS) 2022; 27:809-812. [PMID: 35894853 DOI: 10.1080/16078454.2022.2105513] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
BACKGROUND Hematopoietic stem cell transplantation (HSCT) is a well-recognized therapeutic procedure; costs limit its widespread use in low and middle income countries (LMIC). METHODS Over a 30-year period, we have conducted HSCT in LMIC, making adaptations to the conventional procedures conducted in high-income countries (HIC). RESULTS These salient observations stem from our practice: (1) Start with autologous transplantations in patients with hematological malignancies, specifically multiple myeloma; cell freezing devices are not necessary. (2) Next, consider auto-HSCT in patients with autoimmune diseases. (3) Introduce allogeneic transplants, initially using reduced intensity conditioning regimens. Conducting the HSCT on an outpatient basis is cheaper and safer. (4) Do not build HEPA-filtered rooms nor laminar flow cabins. (5) Do not graft cord blood cells nor start a cord blood blank. (6) Engage in haploidentical transplantations which are more feasible and cost-effective. (7) Matched unrelated donors are extremely expensive. (8) Use generic drugs and biosimilars. (9) Blood product irradiation devices are not necessary. (10) Do not try to reproduce other HSCT programs from HIC; develop your own methods. CONCLUSIONS HSCT can be conducted in LMIC with reduced costs and similar efficacy, thus making this therapeutic option affordable for more persons.
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Affiliation(s)
- Guillermo J Ruiz-Argüelles
- Centro de Hematologia y Medicina Interna, Universidad Popular Autonoma del Estado de Puebla, Puebla, Mexico
| | | | - Guillermo J Ruiz-Delgado
- Centro de Hematologia y Medicina Interna, Universidad Popular Autonoma del Estado de Puebla, Puebla, Mexico
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Stem Cell Therapy in Neuroimmunological Diseases and Its Potential Neuroimmunological Complications. Cells 2022; 11:cells11142165. [PMID: 35883607 PMCID: PMC9318423 DOI: 10.3390/cells11142165] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2022] [Revised: 07/03/2022] [Accepted: 07/06/2022] [Indexed: 12/29/2022] Open
Abstract
Background: Since the 1990s, transplantations of hematopoietic and mesenchymal stem cells (HSCT and MSCT) and dendritic cell (DCT) have been investigated for the treatment of neurological autoimmune disorders (NADs). With the growing number of transplanted patients, awareness of neuroimmunolgical complications has increased. Therefore, an overview of SCT for the most common NADs and reports of secondary immunity after SCT is provided. Methods: For this narrative review, a literature search of the PubMed database was performed. A total of 86 articles reporting on different SCTs in NADs and 61 articles dealing with immune-mediated neurological complications after SCT were included. For multiple sclerosis (MS), only registered trials and phase I/II or II studies were considered, whereas all available articles on other disorders were included. The different transplantation procedures and efficacy and safety data are presented. Results: In MS patients, beneficial effects of HSCT, MSCT, and DCT with a decrease in disability and stabilization of disease activity have been reported. These effects were also shown in other NADs mainly in case reports. In seven of 132 reported patients with immune-mediated neurological complications, the outcome was fatal. Conclusions: Phase III trials are ongoing for MS, but the role of SCT in other NADs is currently limited to refractory patients due to occasional serious complications.
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7
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Cantero-Fortiz Y, Murrieta-Álvarez I, León-Peña AA, López-Trujillo MA, Córdova-Ramírez AC, Rivera-Álvarez M, Elias-de-la-Cruz GD, Olivares-Gazca JC, Ruiz-Delgado GJ, Ruiz-Argüelles GJ. Helicobacter pylori antibodies and multiple sclerosis: a single-center study and a short review of the literature. THE EGYPTIAN JOURNAL OF NEUROLOGY, PSYCHIATRY AND NEUROSURGERY 2021. [DOI: 10.1186/s41983-021-00419-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Multiple sclerosis is an immune-mediated disease which has been associated to a great variety of mechanisms that could influence its pathogenesis. Numerous reports in the medical literature suggest that Helicobacter pylori may be a mediator of the disease. However, it is unknown if there is any clear association between MS and HP.
Results
We studied 144 persons with multiple sclerosis prospectively enrolled in our hematopoietic stem cell transplantation program. In 144 persons, 14% patients were positive for IgG-HP whereas 86% were negative, 8.3% pwMS were IgM-HP positive while 91.6% pwMS were negative, 18% patients were positive and 82% negative for IgA-HP. Significantly lower concentrations of anti-HP IgG were found in RRMS in comparison with SPMS (− 28.5, 95% CI 4.3–52.7). While concentrations of anti-HP IgA were significantly lower in SPMS in comparison with RRMS (0.54, 95% CI 0.1–0.9). In a multivariate analysis, positivity rate of anti-HP IgG was found to be higher in SPMS patients (OR 4.7, 95% CI 1.1–19.6).
Conclusions
There was a negative correlation between the presence of anti-HP antibodies and MS. Further larger studies with specific laboratory testing methods are needed to discard or confirm the potential role of anti-HP antibodies as protective for MS.
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Huo L, Wang H, Yuan Y, Gao J, Liu X. Positive antithyroid antibody predicts severity of neuromyelitis optica spectrum disorder in children. Mult Scler Relat Disord 2021; 57:103425. [PMID: 34906814 DOI: 10.1016/j.msard.2021.103425] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 10/19/2022]
Abstract
BACKGROUND Neuromyelitis optica spectrum disease (NMOSD) is a rare autoimmune disease, which can coexist with autoimmune thyroid diseases (AITDS). There has been no report on the clinical characteristics of NMOSD in children with positive anti-thyroid antibodies (ATAbs). The aim of this study is to evaluate thyroid function and detect the difference between ATAbs seropositive and seronegative NMOSD children. METHODS 108 children with a confirmed diagnosis of NMOSD who were admitted to Shengjing Hospital of China Medical University from January 2015 to September 2020 were enrolled and their thyroid functions were evaluated. They were divided into two groups by ATAbs abnormalities. Their demographic characteristics, clinical symptoms, laboratory and MRI scan results of the brain and spinal cord were assessed. RESULTS ATAbs positive rate was higher in children with NMOSD when compared with healthy controls (P < 0.05). Most NMOSD children with positive ATAbs were female (P < 0.01). The expanded disability status scale (EDSS) score was significantly higher in the ATAbs positive group (P < 0.01). There were statistically significant differences for the incidence of bulbar area postrema symptoms, spinal cord symptoms, and fever of unknown origin of the first onset between the ATAbs positive and negative group (P < 0.05). The ANA and MOG antibody positive rate, longitudinally extensive transverse myelitis (LETM), and electroencephalogram (EEG) were significantly higher in ATAbs positive group (P < 0.05). CONCLUSION MOG antibody-positive is a unique marker of aggravation of neurological dysfunction in ATAbs-positive NMOSD children. Monitoring ATAbs may play an important role in predicting the prognosis of NMOSD.
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Affiliation(s)
- Liang Huo
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
| | - Hua Wang
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Yujun Yuan
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China; Department of Neurological Function, Shengjing Hospital of China Medical University, Shenyang 110004, China
| | - Jian Gao
- Department of Radiology, Shengjing Hospital, China Medical University, Shenyang, China
| | - Xueyan Liu
- Department of Pediatrics, Shengjing Hospital of China Medical University, Shenyang 110004, China.
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Burt RK, Muraro PA, Farge D, Oliveira MC, Snowden JA, Saccardi R, Han X, Quigley K, Bueno V, Frasca D, Fedorenko D, Burman J. New autoimmune diseases after autologous hematopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplant 2021; 56:1509-1517. [PMID: 33911200 DOI: 10.1038/s41409-021-01277-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2020] [Revised: 03/01/2021] [Accepted: 03/19/2021] [Indexed: 02/02/2023]
Abstract
Secondary autoimmune diseases (2ndADs), most frequently autoimmune cytopenias (AICs), were first described after allogeneic hematopoietic stem cell transplantation (HSCT) undertaken for malignant and hematological indications, occurred at a prevalence of ~5-6.5%, and were attributed to allogeneic immune imbalances in the context of graft versus host disease, viral infections, and chronic immunosuppression. Subsequently, 2ndADs were reported to complicate roughly 2-14% of autologous HSCTs performed for an autoimmune disease. Alemtuzumab in the conditioning regimen has been identified as a risk for development of 2ndADs after either allogeneic or autologous HSCT and is consistent with the high rates of 2ndADs when using alemtuzumab as monotherapy. Due to the significant consequences but variable incidence, depending on conditioning regimen, of 2ndADs and similarity in known immune reconstitution kinetics after autologous HSCT for autoimmune diseases and after alemtuzumab monotherapy, we propose that an imbalance between B and T lineage regeneration early after HSCT may underlie the pathogenesis of 2ndADs.
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Affiliation(s)
- Richard K Burt
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
| | - Paolo A Muraro
- Neuroimmunology and Immunotherapy, Department of Brain Sciences, Imperial College London, London, UK
| | - Dominique Farge
- Unité de Médecine Interne: Maladies Auto-immunes et Pathologie Vasculaire (UF 04), IRSL, EA-3518, Université de Paris, MATHEC, Centre de Référence des Maladies auto-immunes systémiques Rares d'Ile-de-France, Filière FAI2R, Hôpital St-Louis, AP-HP, Paris, France
| | - Maria Carolina Oliveira
- Divisão de Imunologia Clínica, Departamento de Clínica Médica, Universidade de São Paulo, Ribeirão Preto, São Paulo, Brazil
| | - John A Snowden
- Department of Haematology, Sheffield Teaching Hospitals, NHS Foundation Trust and the University of Sheffield, Sheffield, UK
| | - Riccardo Saccardi
- Department of Hematology, Careggi University Hospital, Florence, Italy
| | - Xiaoqiang Han
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Kathleen Quigley
- Division of Immunotherapy, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Valquiria Bueno
- Department of Microbiology, Immunology and Parasitology DMIP Federal University of São Paulo UNIFESP, São Paulo, Brasil
| | - Daniela Frasca
- Department of Microbiology and Immunology, and Sylvester Comprehensive Cancer Center, University of Miami Miller School of Medicine, Miami, FL, USA
| | - Denis Fedorenko
- The A.A. Maximov Department of Hematology and Cellular Therapy, National Pirogov Medical Surgical Center, Moscow, Russian Federation
| | - Joachim Burman
- Department of Neurology, Uppsala University, Uppsala, Sweden
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Kasarełło K, Snarski E, Sulejczak D, Ciesielski T, Wiśniewska A, Wrzesień R, Cudnoch-Jędrzejewska A. Post Transplantation Cyclophosphamide Improves Outcome of Autologous Hematopoietic Stem Cell Transplantation in Animal Model of Multiple Sclerosis. Arch Immunol Ther Exp (Warsz) 2021; 69:17. [PMID: 34181099 PMCID: PMC8238731 DOI: 10.1007/s00005-021-00619-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2021] [Accepted: 05/18/2021] [Indexed: 12/03/2022]
Abstract
Experimental allergic encephalomyelitis (EAE) is the animal model of multiple sclerosis (MS). Autologous hematopoietic stem cell transplantation (AHSCT) has recently been recognized as the standard treatment for MS. The aim of our experiment was to investigate the effect of AHSCT with the addition of low-dose post-transplantation cyclophosphamide (Cy) on EAE in rats. Low dose post-transplantation Cy is used in haploidentical HSCT to reduce the risk of graft versus host disease. We hypothesized that it could bring additional benefit in autologous HSCT in autoimmune diseases. Rats with evoked EAE were treated with high dose (125 mg/kg) Cy, followed by AHSCT or high dose (125 mg/kg) Cy followed by AHSCT followed by low dose (20 mg/kg) Cy in two-time schedules—with the therapy applied during the pre-symptomatic or symptomatic phase of the disease. Both AHSCT and AHSCT with post-transplantation Cy in accordance with both time schedules reduce the intensity of the inflammatory response in the CNS, in comparison with non-treated EAE rats. The reduction of clinical symptoms was present in all AHSCT treatment protocols, however, it was significantly stronger when post-transplantation Cy was given during the symptomatic phase of the disease. AHSCT with the addition of post HSCT low dose Cy improved the results of AHSCT by not only reducing the intensity of inflammation in the CNS but also by significantly reducing the clinical symptoms in treated animals when compared to AHSCT alone. We provide an experimental rationale that the addition of post-transplantation Cy may improve the outcome of HSCT in MS.
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Affiliation(s)
- Kaja Kasarełło
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
| | - Emilian Snarski
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland.
| | - Dorota Sulejczak
- Department of Experimental Pharmacology, Mossakowski Medical Research Centre, Warsaw, Poland
| | - Tomasz Ciesielski
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
| | | | - Robert Wrzesień
- Central Laboratory of Experimental Animals, Medical University of Warsaw, Warsaw, Poland
| | - Agnieszka Cudnoch-Jędrzejewska
- Chair and Department of Experimental and Clinical Physiology, Laboratory of Centre for Preclinical Research, Medical University of Warsaw, Banacha 1B, 02-097, Warsaw, Poland
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Murrieta-Álvarez I, Cantero-Fortiz Y, León-Peña AA, Olivares-Gazca JC, Priesca-Marín JM, Ruiz-Delgado GJ, Gómez-De-León A, Gonzalez-Lopez EE, Jaime-Pérez JC, Gómez-Almaguer D, Ruiz-Argüelles GJ. The 1,000th Transplant for Multiple Sclerosis and Other Autoimmune Disorders at the HSCT-México Program: A Myriad of Experiences and Knowledge. Front Neurol 2021; 12:647425. [PMID: 33692748 PMCID: PMC7937693 DOI: 10.3389/fneur.2021.647425] [Citation(s) in RCA: 14] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2020] [Accepted: 02/01/2021] [Indexed: 12/17/2022] Open
Abstract
After gaining experience conducting both auto and allografts in persons with hematological diseases in the HSCT programs in Puebla and Monterrey, México, this study outlines subsequent program autografting patients with autoimmune conditions. The first transplant in multiple sclerosis was conducted in Puebla on July 5, 2006. From 2015 we increased activity autografting persons with autoimmune conditions in the two campuses of the HSCT-México program: Puebla and Monterrey. By December 6, 2020, patient number 1,000 in the program was autografted. In our experience, a significant reduction in the expanded disability status scale score was achieved in all of the three phenotypes of the disease (from a median of 5.1 to 4.5 points), whereas the response rate (defined as a decrease of at least 0.5 of EDSS score regardless of baseline EDSS, or unchanged EDSS) was 83, 78, and 73% after 12 months in the relapsing-remitting, primary-progressive and secondary-progressive forms of multiple sclerosis, respectively. In addition to analyzing the viability, safety, and efficacy of our method, this study contributes new knowledge to the field of both stem cell transplantation and multiple sclerosis.
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Affiliation(s)
- Iván Murrieta-Álvarez
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | - Yahveth Cantero-Fortiz
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Escuela de Medicina, Universidad de las Américas Puebla, Puebla, Mexico
| | - Andrés A León-Peña
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Benemérita Universidad Autónoma de Puebla, Puebla, Mexico
| | - Juan C Olivares-Gazca
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico
| | | | - Guillermo J Ruiz-Delgado
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,Laboratorios Clínicos de Puebla, Puebla, Mexico
| | | | | | | | | | - Guillermo J Ruiz-Argüelles
- Centro de Hematología y Medicina Interna de Puebla, Puebla, Mexico.,Facultad de Medicina, Universidad Popular Autónoma del Estado de Puebla, Puebla, Mexico.,Laboratorios Clínicos de Puebla, Puebla, Mexico
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Olivares Gazca JC, Gómez Almaguer D, Gale RP, Ruiz Argüelles GJ. Mélange intéressante: COVID-19, autologous transplants and multiple sclerosis. ACTA ACUST UNITED AC 2020; 25:320. [PMID: 32783598 DOI: 10.1080/16078454.2020.1802931] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023]
Affiliation(s)
| | - David Gómez Almaguer
- Department of Haematology, Hospital Universitario de Nuevo León, Monterrey, Mexico
| | - Robert Peter Gale
- Haematology Research Centre, Department of Immunology and Inflammation, Imperial College London, London, UK
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Effect of autologous hematopoietic stem cell transplantation on multiple sclerosis and neuromyelitis optica spectrum disorder: a PRISMA-compliant meta-analysis. Bone Marrow Transplant 2020; 55:1928-1934. [PMID: 32020080 DOI: 10.1038/s41409-020-0810-z] [Citation(s) in RCA: 28] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2019] [Revised: 01/15/2020] [Accepted: 01/22/2020] [Indexed: 12/29/2022]
Abstract
We should consider both the treatment effects and adverse effects of autologous hematopoietic stem cell transplantation (AHSCT) on multiple sclerosis (MS) and neuromyelitis optica spectrum disorders (NMOSD). Articles exploring the effect and safety of AHSCT in the treatment of MS and NMOSD and published before December 2019 were identified from the following databases (PubMed, Web of Science, Medline, EMBASE, Cochrane and Google Scholar). The study used STATA 13.0 software to compute the efficacy outcomes. Finally, the meta-analysis included 27 studies (including 1626 MS and 31 NMOSD patients). Regarding the effect of AHSCT on MS, the computed PFS was 74%. Subgroup analyses showed that intermediate-intensity regimen caused PFS 73%. Low-intensity regimen resulted in PFS 85%. High-intensity regimen resulted in PFS 58%. Subgroup analyses indicated that relapsing remitting MS (RRMS), primary progressive MS (PPMS) and secondary progressive MS (SPMS) patients showed PFS 81%, 78% and 60%, respectively. Computed transplant-related mortality (TRM) in MS was 1%. Regarding effect of AHSCT on NMOSD, the computed PFS and TRM was 76% and 0%, respectively. In conclusion, the study supported that AHSCT showed long-term effect on MS and NMOSD patients with a high safety. Low- and intermediate-intensity regimens and RRMS patients showed optimal benefit from AHSCT.
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