Conditioning, PBHSC infusion, and initial recovery usually are performed during an approximately 1-month hospitalization in a specialized transplant unit. Mobilization typically is performed as an outpatient. The principal purpose of the transplant is to shorten the aplastic phase after conditioning and lessen the resultant adverse effects, though some data suggest that it might contribute to immune reconstitution with more normal regulatory function and self-tolerance.
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At Cleveland Clinic, we currently utilize BEAM (carmustine, etoposide, cytarabine, melphalan) plus anti-thymocyte globulin, an intermediate intensity conditioning regimen, for AHSCT for MS. Conversely, the highest intensity myeloablative regimens may have more potent or durable efficacy, but have greater risk. 1 The lower intensity non-myeloablative regimens are better tolerated but may have somewhat less potent or durable efficacy. The optimal intensity conditioning regimen currently is uncertain. Conditioning regimens all are immunoablative but range in intensity from low-intensity non-myeloablative regimens to high-intensity potently myeloablative regimens. The ablative conditioning eliminates the existing immune cells and is the component of the protocol that represents MS disease therapy per se.
Anti-inflammatory strategies – typified by autologous hematopoietic stem cell transplantation (AHSCT).
Two general stem-cell-based therapeutic strategies have been considered in MS: 1 Induced pluripotent stem cells – stem cells generated from adult somatic cells through molecular reprogramming.Adult stem cells – various types of stem cells present in virtually all body tissues in the adult, including neural stem cells and oligodendrocyte progenitor cells in the adult central nervous system.
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