دکتر سید سلمان فاطمی . نورولوژیست:
تلاشی جدید در درمان بیماران دچار ام اس (مولتيپل سالروز)
در این مورد ، کوشش میشود ، سلول ایمنی قبلی که علیه پوشش میلین اعصاب واکنش میدهد با سلولهای ایمنی جدید که واکنشي با پوشش میلین ندارند جایگزین شوند .
در این درمان جدید از پیوند مغز استخوان استفاده میشود . در ابتدا بدن در معرض شیمی درمانی با دوز بالا قرار می گیرد تا مغز استخوان قبلی و سلولهای ایمنی از میان برود
سپس سلولهای جدید مغز استخوان که یا از خود بیمار تهیه شده و یا از دو قلو یا برادر و خواهر بیمار گرفته شده است از طریق سیاهرگ به خون بیمار وارد میشود تا سلولهای جدید ایمنی ساخته شود.
در مطالعه فعلی در کانادا ، 24 بیمار با رلاپسهاي متعدد (حداقل یک بار در سال ) مورد پیوند مغز استخوان قرار گرفتند و نکته جالب آن بود که جز یکی از آنها ، بقیه طی سیزده سال هیچ حمله ای نداشتند
Reza Farhad Manteghi Fasaei:
MS Remissions Last 13 Years in Canadian Stem Cell Study
Alicia Ault
June 10, 2016
NATIONAL HARBOR, Maryland — All but 1 of the 24 patients with relapsing-remitting multiple sclerosis (MS) participating in a Canadian study were relapse-free for as long as 13 years after receiving autologous hemopoietic stem cell transplantation (aHSCT), new data show.
The results were presented at the Consortium of Multiple Sclerosis Centers (CMSC) 2016 Annual Meeting by lead investigator Mark S. Freedman, MD, professor of medicine, University of Ottawa, Ontario, Canada. They are also published online June 9 in The Lancet.
Before transplantation, the 24 patients in the Canadian MS Bone Marrow Transplantation Study https://mssociety.ca/research-news/stem-cells/canadian-bone-marrow-transplantation-bmt-trial experienced 167 relapses, or 1.2 per patient per year, said Dr Freedman. After transplant, there were no relapses in the 23 surviving patients, out to 13 years of follow-up.
However, 1 patient (4%), died of hepatic necrosis and sepsis attributed to the chemotherapy regimen.
The rationale behind the stem cell transplant was to remove the diseased immune system and replace it with a fully functional system that would not redevelop MS. Even with that aim, the trialists had designed experiments to monitor signs that the disease was returning. But that has not happened.
"I was completely skeptical that we'd be able to achieve this," Dr Freedman told Medscape Medical News in an interview during the CMSC meeting.
But the results validate the goal set by these investigators. "If you're going to the extent of doing bone marrow transplant, you want to arrest the disease," he said. "You don't want to buy people 2 or 3 years of NEDA [no evidence of disease activity] and then have to take drugs again."
Mortality Rate "Unacceptably High"
In a linked commentary accompanying the Lancet publication, Jan Dörr, MD, from the NeuroCure Clinical Research Center, Charité-Universitätsmedizin, Berlin, Germany, called the results, "impressive and seem to outbalance any other available treatment for multiple sclerosis."
This trial is the first to show complete suppression of any inflammatory disease activity in every patient for a long period, Dr Dörr writes. "However, aHSCT has a poor safety profile, especially with regards to treatment-related mortality."
The study will probably not change the treatment for MS in the short term, he cautions, "mainly because the mortality rate will still be considered unacceptably high.
"Over the longer term [and] in view of the increasing popularity of using early aggressive treatment, there may be support for considering aHSCT less as a rescue therapy and more as a general treatment option, provided the different protocols are harmonised and optimised, the tolerability and safety profile can be further improved, and prognostic markers become available to identify patients at risk of poor prognosis in whom a potentially more hazardous treatment might be justified."
Michael K. Racke, MD, professor of neurology and neuroscience at Wexner Medical Center at the Ohio State University in Columbus, also called the results impressive. "They didn't see any evidence after transplant of any patients having MRI lesions," Dr Racke told Medscape Medical News. On the
آدرس مطب : اصفهان ، خیابان آمادگاه ، روبروی داروخانه سپاهان ، مجتمع اطبا ، طبقه اول
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