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Among the 18 cases with a follow-up longer than 7 years, eight (44%) remained stable or had a sustained improvement while 10 (56%), after an initial period of stabilization or improvement with median duration of 3.5 years, showed a slow disability progression.

Cognitive fatigue in individuals with multiple sclerosis undergoing immunoablative therapy and hematopoietic stem cell transplantation.
Twenty-three individuals with rapidly progressive MS and poor prognosis underwent high dose immunosuppression and subsequent HSCT. Individuals completed the 3″ and 2″ PASAT at baseline and every 6months thereafter over a period of 36months. As scoring methodology can impact its sensitivity to cognitve fatigue (CF), the PASAT was scored according to three scoring methods.
RESULTS:
CF was noted across all three scoring methods at baseline and at the majority of time points post-IA-HSCT on both the 3″ and 2″ PASAT. The magnitude of CF remained consistent both pre-and post-IA-HSCT.
CONCLUSIONS:
While results suggest that the procedure itself does not ameliorate an individual's susceptibility to CF; neither does it seem to negatively impact levels of CF. As such, results support the notion that the IA-HSCT procedure, despite its aggressive nature, does not exacerbate CF in this particular sample.

Diminished Th17 (not Th1) responses underlie multiple sclerosis disease abrogation after hematopoietic stem cell transplantation.

Clinical and brain magnetic resonance imaging measures of disease activity were monitored serially in patients participating in the Canadian MS HSCT Study. Reconstitution kinetics of immune-cell subsets were determined by flow cytometry, whereas thymic function was assessed using T-cell receptor excision circle analyses as well as flow cytometry measurements of CD31+ recent thymic emigrants (RTEs). Functional assays were performed to track central nervous system-autoreactive antigen-specific T-cell responses, and the relative capacity to generate Th1, Th17, or Th1/17 T-cell responses.
RESULTS:
Complete abrogation of new clinical relapses and new focal inflammatory brain lesions throughout the 2 years of immune monitoring following treatment was associated with sustained decrease in naive T cells, in spite of restoration of both thymic function and release of RTEs during reconstitution. Re-emergence as well as in vivo expansion of autoreactive T cells to multiple myelin targets was evident in all patients studied. The reconstituted myelin-specific T cells exhibited the same Th1 and Th2 responses as preablation myelin-reactive T cells. In contrast, the post-therapy T-cell repertoire exhibited a significantly diminished capacity for Th17 responses.
INTERPRETATION:
Our results indicate that diminished Th17 and Th1/17 responses, rather than Th1 responses, are particularly relevant to the abrogation of new relapsing disease activity observed in this cohort of patients with aggressive MS following chemoablation and HSCT.

Hematopoietic stem cell therapy for multiple sclerosis: top 10 lessons learned.
Atkins HL, Freedman MS.
Source
Ottawa Hospital Research Institute, Ottawa, Canada. hatkins@ohri.ca
Abstract
Reports from more than 600 hematopoietic stem cell transplants (HSCT) have appeared in the medical literature for the last 1 and one-half decades. The patient's own stem cells are harvested and stored temporarily while high doses of chemotherapy and biologics are used to destroy the auto-destructive immune system. The immune system is regenerated from the infused autologous hematopoietic stem cells. Increasing clinical experience has refined patient selection criteria and management in the peri-transplant period leading to a reduction in treatment-related complications. HSCT, when used to treat patients with aggressive highly active multiple sclerosis, can reduce or eliminate ongoing clinical relapses, halt further progression, and reduce the burden of disability in some patients, in the absence of chronic treatment with disease-modifying agents. The top 10 lessons learned from the growing experience using HSCT for the treatment of multiple sclerosis are discussed.

Any comments

AMS (aggressive multiple sclerosis) was identified in 4-14% of patients, depending on the definition used.

In a long-term follow-up of 158 untreated patients who experienced more than three relapses in the first 2 years following diagnosis, only two-thirds converted to SP in a median of just 5 years. For unknown reasons, one-third of people seemed resilient to the numerous early setbacks (Scalfari et al., 2013).

But if the early flare-ups are not causally linked to SP, treating those exacerbations may not delay or prevent SP, at least for some people........Clinicians and scientists believed that relapses drove disability, she says. "Now, it seems more likely that this is not the case neurodegeneration ultimately puts someone in a wheelchair and alters their long-term outcome."

Overall, cumulative relapses had only a minimal impact on long-term disease progression. Their findings came from a retrospective review of nearly 2500 patients in British Columbia with a median follow-up of about 20 years (Tremlett et al., 2009).

Leonard wrote:Thanks Cheer, Sharon for your comments, true, all so true.

I can see a further reason: things are going very fast now, around the whole wide world. Doctors in the US and in Germany can stop the autoimmunity by tagging a protein to (T-; nano) cells and giving it back to the patient; medication for promoting remyelination will come soon; the understanding of the all important role of the gut in autoimmunity gains ground very fast and also what to do about it. These Ottawa doctors may be just afraid their work and the value it may represent are going to be lost in the noise.

CureOrBust wrote:Will their work be lost in the noise, or is noise all that we hear.

CureOrBust wrote:Will their work be lost in the noise, or is noise all that we hear.