Source: MSDiscovery.org
A new study shows good outcomes using a less intense conditioning regimen, suggesting it may be possible to perform successful stem-cell transplants in multiple sclerosis patients with less risk of infection
CYNTHIA MCKELVEY
Cartoon by Cynthia McKelvey.
According to some, 2015 is the year of the future. And that tongue-in-cheek superlative (derived from the 1989 movie, Back to the Future Part II) may be deserved, at least in the field of medicine. Earlier this month, MSDF covered a story about optimistic results from the phase 2 “HALT-MS” trial testing hematopoietic cell transplantation (HCT) in relapsing-remitting multiple sclerosis (RRMS) patients (Nash et al., 2014 . More recently, another research team published results from a separate phase 2 trial testing a different HCT method that had similar results to HALT-MS (Burt et al., 2015). It seems in 2015, the question isn’t “Can we do this?” but “How should we do this?”
The goal of autologous HCT is to “reset” the patient’s immune system. It’s a multistep process. First, stem cells must be harvested from the patient’s bone marrow, or in the case of allogeneic transplants, from a healthy volunteer. Then the patient is subjected to a conditioning regimen to knock back the immune system. Finally, the stem cells are reintroduced, and if everything goes according to plan, the procedure reboots the patient’s immune system.
Conditioning regimens come in two flavors: myeloablative and nonmyeloablative. Myeloablative regimens, like those used in HALT-MS, aim to eradicate the patient’s bone marrow—and thereby the immune system—in order to give the patient a clean slate. But myeloablative regimens put the patient at high risk for infection. In contrast, nonmyeloablative regimens, such as the one used in the more recently published study, are less risky because they leave some of the bone marrow intact.
The results
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