Thursday, 17 March 2016

HSCT Russian Style

Makarov SV, Rossiev VA, Mishchenko OV, Kozlov VA, Semagina OV, Aleksandrova IY, Grishina GV, Minaev YL.[The role and place of high-dose immunosuppressive therapy and autologous transplantation of hematopoietic stem cells for autoimmune diseases]. Ter Arkh. 2016;88(1):53-59.

AIM:To determine the possible boundaries of high-dose immunosuppressive therapy and autologous haematopoietic stem cell transplantation (HDIT-autoHSCT) for autoimmune diseases (AUDs), such as systemic lupus erythematosus (SLE), rheumatoid arthritis (RA), and multiple sclerosis (MS).
MATERIAL AND METHODS: A long-term trial was conducted at one center to evaluate the efficiency and safety of HDIT-autoHSCT in patients with AUDs. The previous standard therapy was noted to be resistant or lowly effective. The age of 10 patients with systemic connective tissue diseases was 27.6±2.8 years; the pre-HDIT-autoHSCT disease duration was 5.9±1.3 years; the median posttransplantation follow-up was 39.3 months. The age of 49 patients with MS reached 34.9±1.33 years; the pretransplantation disease duration was 8.4±0.69 years; the median post-HDIT-autoHSCT follow-up was 42 months. The efficiency of transplantation was evaluated on the basis of clinical findings, by using scales, laboratory tests, and magnetic resonance imaging. Pretransplantation conditioning was carried out according to the protocols: a) BEAM + antilymphocyte globulin (ALG); b) fludarabine + melphalan + ALG. No fatal outcomes due to a transplant procedure were observed.
RESULTS:Overall 5-year survival after transplantation was 80% for systemic connective tissue diseases and 95% for MS; 5-year progression-free survival rates were 30% in the RA and SLE groups and 45% in the MS group. HDIT-autoHSCT turned out safe and reduced the activity of the process and further disease progression for a long period of time, as confirmed by regression of clinical symptoms and/or status stabilization in 9 patients with SLE or RA and in all patients with MS.
CONCLUSION:The favorable factors associated with the results of transplantation are age younger than 35 years in collagenoses with their short-term duration and moderate signs; age younger than 40 years in MS with a disease duration of less than 10 years and expanded disability status scale scores of not more than 6.5. Of importance are functional system scores, duration of first remission, and an index of disease progression in different types of MS.

The manuscript is written in Russian so I can't say too much, but what it says about HSCT is treat early before damage is done, which has been our manta for treatment  approaches. Now it says there were no fatalities from treatment but what is survival at 5 years meaning that 5% passed. NEDA at 5 years was about 50%.

However you get the gist.

The question is this any better than treatment such as alemtuzumab. Yes the risk of secondary autoimmunities appears lower but they do occurr in people with MS even when alemtuzumab is not part of the immune conditioning regime

5 comments:

  1. I heard the Russians use plutonium as part of their chemo protocal.

    ReplyDelete
  2. my partner chose non myelo hsct to try and avoid or delay the secondary autoimmunity (yes, could still happen, but roll the odds yada yada yada). wasn't so much a debate on which is better, but which side effects she could live with better. her blood counts 3 months post hsct are the same as that of a person who received lemtrada 3 months ago. she doesn't thinks she's been cured though she hopes she's bought herself enough time before she has to consider next steps in her treatment.

    ReplyDelete
  3. Interesting choice of publication to comment upon. How about commenting on the REAL style of Russian HSCT as demonstrated by Moscow?

    http://www.ncbi.nlm.nih.gov/m/pubmed/25711670/?i=3&from=/26978610/related

    ReplyDelete
    Replies
    1. Hi Mindy
      If you care to read the blog you will find that this paper was covered when it was published

      http://multiple-sclerosis-research.blogspot.com/2015/03/crowdspeak-russian-experience-of-hsct.html

      Delete

Please note that all comments are moderated and any personal or marketing-related submissions will not be shown.