Friday, 26 February 2016

Collecting Stem Cells

Kyrcz-Krzemień S, Helbig G, Torba K, Koclęga A, Krawczyk-Kuliś M. Safety and efficacy of haematopoietic stem cells mobilization in patients with multiple sclerosis. Hematology. 2016 Feb. [Epub ahead of print]

Introduction Multiple sclerosis (MS) is a T-cell-mediated chronic inflammatory disorder of the central nervous system. Several agents have been approved for treatment of MS, however their efficacy is limited and short term. Autologous haematopoietic stem cell (HSC) transplantation may remain an encouraging option for some MS patients who failed prior conventional treatment. Objective To assess the safety and effectiveness of HSCs mobilization in patients with MS. 
Material and methods Thirty-nine patients (20 females, 19 males) with relapsing-remitting MS at median age of 40 years (range 25-63) were included in this study. As a stem cell mobilization they received either granulocyte colony-stimulating factor (G-CSF) alone (10 μg/kg s.c. daily; n = 1) or cyclophosphamide (CY; 2.0 g/m2 i.v. on days 1-2) followed by G-CSF (n = 38). 
Results The median number of mobilized HSCs per kilogram was 6.32 × 106 (range 2.64-26.3 × 106). One apheresis was sufficient for collection of HSCs in 30 out of 39 MS patients (77%). Two aphereses were required for seven patients, three for one patient, and four for one patient (17, 3, and 3%, respectively). 
Side effects of HSCs mobilization have been reported for eight patients (30%) and they were as follows: Staphylococcus epidermidis bacteremia (n = 1), fever of unknown origin (n = 3), diarrhea (n = 3), and headache (n = 1). 
Conclusions Mobilization using CY and/or G-CSF resulted in effective mobilization in all MS patients. This procedure was found to be safe. No fatal outcome has been reported.

This study takes about stem cell mobilization from the bone marrow into the blood. This is the first part of the immunosuppression. 

Apheresis (ἀφαίρεσις (aphairesis, “a taking away”)) is a medical technology in which the blood of a donor or patient is passed through an apparatus that separates out one particular constituent and returns the remainder to the circulation.

Other agents are then used  to deplete the immune system such as ant-T cell treatments.

5 comments:

  1. Somehow they forgot to include the loss of hair in the side effects of this mobilisation protocol. Apparently the doctors focused too much on headache and diarrhea cases and overlooked those rapidly balding patients' heads.
    (Not that it is terribly important, next dose of chemo in the transplantion phase kills the hair even more effectively anyway, but it is strange to omit this side effect in the study).

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    1. I have not read the full article, but I hope that the study did more for its participants then feeding them GCF and/or cyclosphomide to randomly mobilise their stem cells.... At the risk of being labelled a grammar nazi again, stem cell mobilisation from bone marrow to blood is not the first part of immunosuppression - it is almost the opposite of immunosupression. It stimulates the blood marrow to make more white cells than it usually does, so that they can be collected in sufficient numbers quickly (or it is given to cancer patients who are neutropenic to stimulate their white cells). I'm not sure what new news this study gives us - side effects of GCSF are well documented. It turns out they're very similar in 39 MS patients as they are in the countless non MS patients who received GCSF before them! But I guess someone got another paper published....

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    2. hopefully some kind of induction therapy followed the mobilisation and collection of stem cells, so the patients would have likely gone bald anyway... but the 39 patients studied in this protocol do not all appear to have suffered from known side effects of GCSF so I'm not really sure what this study confirmed or uncovered...

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    3. Grammar nazi...it is G-CSF not GCF...Cyclophosphamide is an immunosuppressive...it destoy B cells and activated T cells at the same time as mobilizing stem cells and making you hair fall out.

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    4. yeah i know, but i'm a lazy grammar nazi... notice i can't even be bothered capitalising beginnings of sentences or spell checking half the words i write (and i'm not picking on the s which fell off the word 'destroy').

      according to a number of cancer sites, GCSF on its own can lead to hair loss (amongst other things), eg - http://www.neutropenianet.org/treatment/

      Apparently the fancy name for hair falling out is Alopecia (learn something new all the time). But as I said, hopefully after being given GCSF, the patients were given something immunosuppressive as well and if so, it would be hard to tell what's causing what.

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