Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients
Abstract Autologous hematopoietic stem cell transplantation (AHSCT) has been used in the treatment of highly active multiple sclerosis (MS) for over two decades. It has been demonstrated to be highly efficacious in relapsing–remitting (RR) MS patients failing to respond to disease-modifying drugs (D...
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doaj-63fb3bae40a147a9aa7555f2c06906182021-06-20T11:18:16ZengAdis, Springer HealthcareNeurology and Therapy2193-82532193-65362020-06-019219720310.1007/s40120-020-00200-9Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis PatientsAntonio Bertolotto0Serena Martire1Luca Mirabile2Marco Capobianco3Marco De Gobbi4Daniela Cilloni5Neurologia—CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi GonzagaNeurologia—CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi GonzagaNeurologia—CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi GonzagaNeurologia—CRESM (Centro Riferimento Regionale Sclerosi Multipla), AOU San Luigi GonzagaSSD Terapia oncoematologica intensiva e trapianto CSE, AOU San Luigi Gonzaga, Dipartimento di Scienze Cliniche e Biologiche, University of TurinSSD Terapia oncoematologica intensiva e trapianto CSE, AOU San Luigi Gonzaga, Dipartimento di Scienze Cliniche e Biologiche, University of TurinAbstract Autologous hematopoietic stem cell transplantation (AHSCT) has been used in the treatment of highly active multiple sclerosis (MS) for over two decades. It has been demonstrated to be highly efficacious in relapsing–remitting (RR) MS patients failing to respond to disease-modifying drugs (DMDs). AHSCT guarantees higher rates of no evidence of disease activity (NEDA) than those achieved with any other DMDs, but it is also associated with greater short-term risks which have limited its use. In the 2019 updated EBMT and ASBMT guidelines, which review the clinical evidence of AHSCT in MS, AHSCT indication for highly active RRMS has changed from “clinical option” to “standard of care”. On this basis, AHSCT must be proposed on equal footing with second-line DMDs to patients with highly active RRMS, instead of being considered as a last resort after failure of all available treatments. The decision-making process requires a close collaboration between transplant hematologists and neurologists and a full discussion of risk–benefit of AHSCT and alternative treatments. In this context, we propose a standardized protocol for decision-making and informed consent process.https://doi.org/10.1007/s40120-020-00200-9ASBMTAutologous hematopoietic stem cell transplantationClinical optionCostsEBMT-ADWPGuidelines |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Antonio Bertolotto Serena Martire Luca Mirabile Marco Capobianco Marco De Gobbi Daniela Cilloni |
spellingShingle |
Antonio Bertolotto Serena Martire Luca Mirabile Marco Capobianco Marco De Gobbi Daniela Cilloni Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients Neurology and Therapy ASBMT Autologous hematopoietic stem cell transplantation Clinical option Costs EBMT-ADWP Guidelines |
author_facet |
Antonio Bertolotto Serena Martire Luca Mirabile Marco Capobianco Marco De Gobbi Daniela Cilloni |
author_sort |
Antonio Bertolotto |
title |
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients |
title_short |
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients |
title_full |
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients |
title_fullStr |
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients |
title_full_unstemmed |
Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients |
title_sort |
autologous hematopoietic stem cell transplantation (ahsct): standard of care for relapsing–remitting multiple sclerosis patients |
publisher |
Adis, Springer Healthcare |
series |
Neurology and Therapy |
issn |
2193-8253 2193-6536 |
publishDate |
2020-06-01 |
description |
Abstract Autologous hematopoietic stem cell transplantation (AHSCT) has been used in the treatment of highly active multiple sclerosis (MS) for over two decades. It has been demonstrated to be highly efficacious in relapsing–remitting (RR) MS patients failing to respond to disease-modifying drugs (DMDs). AHSCT guarantees higher rates of no evidence of disease activity (NEDA) than those achieved with any other DMDs, but it is also associated with greater short-term risks which have limited its use. In the 2019 updated EBMT and ASBMT guidelines, which review the clinical evidence of AHSCT in MS, AHSCT indication for highly active RRMS has changed from “clinical option” to “standard of care”. On this basis, AHSCT must be proposed on equal footing with second-line DMDs to patients with highly active RRMS, instead of being considered as a last resort after failure of all available treatments. The decision-making process requires a close collaboration between transplant hematologists and neurologists and a full discussion of risk–benefit of AHSCT and alternative treatments. In this context, we propose a standardized protocol for decision-making and informed consent process. |
topic |
ASBMT Autologous hematopoietic stem cell transplantation Clinical option Costs EBMT-ADWP Guidelines |
url |
https://doi.org/10.1007/s40120-020-00200-9 |
work_keys_str_mv |
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