44 - Hematopoietic stem cell transplantation to treat multiple sclerosis

Summary

Hematopoietic stem cell (HSC) can be either allogeneic (from another person) or autologous (from the recipient). Autologous hematopoietic stem cell transplantation (HSCT) was first suggested by Burt as a form of intense immunesuppressive therapy. HSCT was proposed as a treatment for multiple sclerosis (MS) based on favorable results in experimental autoimmune encephalomyelitis (EAE), an animal model of MS. The toxicity and efficacy of an autologous HSCT is entirely a consequence of the conditioning regimen. Initial HSCT protocols employed aggressive malignancy-specific myeloablative regimens in patients with progressive MS. Unlike autologous HSCT, the immune compartment arising from allogeneic stem cells have a different and presumably more disease-resistant genetic predisposition towards disease recurrence. Both autologous and allogeneic HSCT require a chemotherapy conditioning regimen to suppress or ablate the immune system. HSCT is the only therapy to consistently demonstrate improvement in neurological disability.