It affects ~2.3 million people worldwide with a prevalence of 1 in 700 adults. MS is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS) and the leading cause of non-traumatic neurological disability of young adults. Other experimental cell therapies are developmental for these diseases and patients should only be treated on clinical trials. Compared with other immunomodulatory treatments, HSCT is associated with greater short-term risks and requires close interspeciality collaboration between transplant physicians and neurologists with a special interest in these neurological conditions before, during and after treatment in accredited HSCT centres. Allogeneic HSCT should only be considered where potential risks are justified. aHSCT may have a potential role in the treatment of the progressive forms of MS with a significant inflammatory component and other immune-mediated neurological diseases, including chronic inflammatory demyelinating polyneuropathy, neuromyelitis optica, myasthenia gravis and stiff person syndrome. The major focus is on autologous HSCT (aHSCT), used in MS for over two decades and currently the fastest growing indication for this treatment in Europe, with increasing evidence to support its use in highly active relapsing remitting MS failing to respond to disease modifying therapies. These updated EBMT guidelines review the clinical evidence, registry activity and mechanisms of action of haematopoietic stem cell transplantation (HSCT) in multiple sclerosis (MS) and other immune-mediated neurological diseases and provide recommendations for patient selection, transplant technique, follow-up and future development. for the European Society for Blood and Marrow Transplantation (EBMT) Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of the International Society for Cellular Therapy (ISCT) and EBMT (JACIE)īone Marrow Transplantation volume 55, pages 283–306 ( 2020) Cite this article.In the case of AITL, understanding the biology of the disease by molecular sequencing and laboratory investigation has directly translated into novel more disease-focused treatments and hope for patients, Foss added.Autologous haematopoietic stem cell transplantation and other cellular therapy in multiple sclerosis and immune-mediated neurological diseases: updated guidelines and recommendations from the EBMT Autoimmune Diseases Working Party (ADWP) and the Joint Accreditation Committee of EBMT and ISCT (JACIE) For those patients who cannot undergo transplants or who do not respond to chemotherapy, a number of clinical trials with novel agents and immunotherapies are currently underway. Most patients with AITL are not cured with chemotherapy alone, and the recommendation is that patients undergo an autologous stem cell transplant with high dose chemotherapy and infusion of their own stem cells once they are in remission from chemotherapy,” Foss added.Ī transplant has a cure rate of over 50% of patients. “Newer approaches have included novel drugs which target proteins or the epigenetic mutations in the cells. “AITL is treated with aggressive chemotherapy,” said Foss. One regimen called CHOP ( cyclophosphamide doxorubicin, vincristine, and prednisone) is a combination of chemotherapy drugs commonly utilized for this disease, Alam stated.Īnother option is CHOEP, with the addition of etoposide.Ĭorticosteroids like prednisone help reduce inflammation, manage symptoms and may also kill cancer cells.Ĭhemotherapy agents can be combined with a targeted therapy called brentuximab if a person has a certain gene marker on lymphoma cells, Alam added.Ī stem cell transplant after high-dose chemotherapy may also be considered to increase the chance of cure. What is the first-line treatment for AITL?Ĭhemotherapy is the most common treatment option for AITL.
0 Comments
Leave a Reply. |
AuthorWrite something about yourself. No need to be fancy, just an overview. ArchivesCategories |