Unsuccessful autologous stem cell transplantation (ECTRIMS)
 

This study was really depressing. One of the more extreme therapies being tried is autologous stem cell transplantation, in which stem cells are harvested from the bone marrow of the patient, the immune system is destroyed with chemotherapy, then rebuilt.

The procedure has a mortality risk of 5% - 10%. Some reported results of this procedure -- which of course are never double-blind -- have seemed promising.

But this abstract makes clear that at least in some patients -- particularly those with higher EDSS scores -- the procedure doesn't work.

Multiple sclerosis pathology after autologous stem cell transplantation: ongoing demyelination and neurodegeneration despite suppressed inflammation

I. Metz, C.F. Lucchinetti, H. Openshaw, A. Garcia-Merino, H. Lassmann, M. Freedman, B. Azzarelli, O.J. Kolar, H.L. Atkins, W. Brück (Gottingen, D; Rochester, Duarte, USA; Madrid, E; Vienna, A; Ottawa, CAN; Indianapolis, USA)

Autopsy material from five multiple sclerosis patients who had received autologous stem cell transplantation was analysed. A total of 53 white matter lesions were investigated using routine and immunohistochemical stainings to characterise the demyelinating activity, inflammatory infiltrates, acutely damaged axons and macrophages/microglial cells.

We found active demyelination in all of the five patients. The inflammatory infiltrate within the lesions showed a tenfold reduction compared to literature data from chronic MS autopsy lesions and CD8+ cytotoxic T cells dominated the T cell population. High numbers of acutely damaged axons were found in active lesion areas.

Tissue injury was associated with activated macrophages/microglial cells. The present results indicate an ongoing demyelination and axonal degeneration despite pronounced immunosuppression. Our data parallel results from clinical phase I/II studies showing continued clinical disease progression in MS patients with high expanded disability system scores despite autologous stem cell transplantation.

I think Dayle was either doing this treatment a couple of years ago, or was looking into it as her MS was very active and aggressive.

By the way Mark , are you still doing pretty well on Copaxone? I hope so. Did you know that there is a guy with MS in your area that swims marathons and coaches swimming? He posted on MSWorld a few times and his name is Vance High. You can google him. I just thought of you when he posted cuz he is from your region and he is male, and he is still atheltically involved, like yourself. :)

Mark, is this that small trial that was done in eastern Canada, whereby 9 people tried the treatment, and one died?

Do you remember that?

If it is, then are they saying that 5 of those people have died now, and that's how they got this study info?

Wow, if so . . .

Cherie

It looks like that is a collection of data including the Canadian trial-but also others. One has died in the Candian trial. One had a very close call. A friend of mine got as far as the prep for it and ened up with a severe flare and paralysis. Not sure if she will be able to continue the study.

I would no longer qualify for the study, as they consider me progressive not rrms now..though they waffle sometimes.:rolleyes:

Is that 5-10 per cent mortality rate still valid then? How many have been in the study...still recruiting? so many questions and if five have died that is very sad indeed. Dayle, I am so glad you didn't go for this route when offered to you! Thanks Mark!

5-10% is the fatality rate for this procedure. You can see the authors of this study were at a number of sites in the US, Canada, Spain and Austria. I would expect the fatality rate to be higher in a group of people with higher EDSS and longer duration of disease. That is why they limit participation in the Canadian trial to people early in disease course and must be ambulatory.
I no longer qualify for the study because I no longer have clear attacks and remissions, and i am 7 years since onset.

There was a similar study done with patients who had suffered heart attacks. I heard about it on the news last week but do not know where the study was conducted or how many people were in the study.

They were doing autologous bone marrow injections into disease heart muscle after a heart attack. All patients got an injection but some got their own bone marrow and others a placebo. The patients who got thier own bone marrow , at one year were doing slightly better than those with the placebo (something like 4.8% improvement in placebo group and 5.4% in bone marrow group...not accurate but the rates were in this neighborhood statistically) However, at the two year mark, those who had received had improved cardiac output and general overall fitness while the placebo group had deteriorated and some had succumbed to additional heart attacks and a couple had died.

It certainly causes one to wonder if we do not have some ability to repair our bodies with techniques of this nature.

It's quite depressing. But maybe also telling. Thanks for posting it, Mark.