AUTOLOGOUS STEM CELL TRANSPLANT SKIN
AUTOLOGOUS STEM CELL TRANSPLANT TRIAL

141, 189 Autoimmune diseases often have pretransplant disease-related immune abnormalities. However, the same slow recovery of CD4 +, rapid return of CD8 + cells, and inverted CD4/CD8 ratio has been reported. To date little data have been reported on immune reconstitution after autologous HSCT for autoimmune diseases. 188 The principles of immune reconstitution that affect autologous and allogeneic HSCT for malignancies (i.e., thymic recovery) probably apply equally well to autoimmune diseases. Richard K Burt, Larissa Verda, in Handbook of Stem Cells, 2004 Autoimmune DiseasesĪutologous HSCT is being performed for an increasing number of autoimmune diseases. The results are urgently needed to determine the true role of HSCT in SSc ( Ramos-Casals et al., 2010).Ī successful treatment of digital ulcers with local stem cell transplantation has also been reported ( Nevskaya et al., 2009). Multicenter, randomized controlled trials of autologous HSCT for SSc, such as the ASTIS and SCOT trials, are currently ongoing in Europe and the US.

AUTOLOGOUS STEM CELL TRANSPLANT SKIN

In 26 SSc patients, Vonk and colleagues observed that autologous HSCT in selected patients with severe diffuse cutaneous SSc resulted in sustained improvement of skin thickening and stabilization of organ function (e.g., pulmonary, cardiac, and renal) up to seven years after transplantation ( Vonk et al., 2008). Progression of interstitial pneumonia was prevented for 48 months ( Tsukamoto et al., 2006). Skin sclerosis markedly improved within six months and was maintained for 48 months in all patients. Clinical and immunological analyses were conducted for four years. In a long-term study of 11 SSc patients, Tsukamoto and colleagues evaluated the efficacy of HSCT. Sevdalina Lambova, Ulf Müller-Ladner, in Genomic and Personalized Medicine (Second Edition), 2013 Stem Cell TransplantationĪutologous hematopoietic stem cell transplantation (autologous HSCT) has emerged as a new therapeutic procedure for patients affected by severe SSc refractory to conventional treatments. 42 Autologous HSCT showed to be superior to MTX in reducing the number of new and active MRI lesions as well as the annualized relapse rate but not disease progression.

AUTOLOGOUS STEM CELL TRANSPLANT TRIAL

A multicenter, randomized, phase II study (ie, Autologous Hematopoietic Stem Cell Transplantation trial in MS) has been performed to assess the effect on the disease activity of autologous HSCT compared to mitoxantrone (MTX), an approved treatment for aggressive MS. On that note, an important step toward the positioning of autologous HSCT within the treatment algorithm of MS patients has been performed. However, the ever-growing spectrum of very effective approved drugs for MS, such as natalizumab and, more recently, alemtuzumab, imposes a reevaluation of autologous HSCT indications.

Those patients could benefit from considerable persistent suppression of disease activity without the need for further therapies. HSCT seems particularly fit for young patients, with short disease duration, no or minor irreversible disability, and a malignant presentation.

Martino, in Translational Neuroimmunology in Multiple Sclerosis, 2016 27.2.6 ConclusionsĪutologous HSCT has been recognized as a clinical option for refractory MS. 163 Immunization with tetanus toxoid, diphtheria toxoid, and inactivated poliovirus is recommended after autologous HSCT. 162 Vaccination with reduced-dose pertussis vaccine (Tdap) failed to induce immune responses in most autologous HSCT recipients. 160 The immune response early after autologous HSCT can be improved by immunizing the patient before the stem cell harvest followed by tetanus toxoid given repeatedly after autologous HSCT. 83, 157, 159, 160 There was no difference in response in autologous bone marrow or peripheral blood stem cell graft recipients. 156 Reimmunization with repeated doses of inactivated poliovirus vaccine, diphtheria toxoid, and tetanus toxoid effectively restores protective immunity. Per Ljungman, in Vaccines (Sixth Edition), 2013 Tetanus toxoid, diphtheria toxoid, pertussis, and poliovirus vaccinesĪutologous HSCT recipients have an increased risk, compared with the healthy population, for loss of protective immunity to poliovirus, 157, 159 diphtheria, 159 and tetanus.

Autologous stem cell transplant