High-dose immunosuppressive therapy with PBPC support in the treatment of poor risk multiple sclerosis

High-dose immunoablative chemotherapy with autologous haematopoietic cell s upport might be beneficial in the treatment of intractable forms of MS. We mobilised PBPC in 11 patients with secondary progressive MS and finally eig ht patients were grafted after high-dose BEAM chemotherapy with either in v itro or in vivo T cell depletion. Median EDSS and SNRS scores at the time o f inclusion were 6.5 (6.5-7.5) and 56 (44-65), respectively. PBPC mobilisat ion was safe with no serious adverse effects, and without significant aggra vation of disability, One patient improved significantly (by 1.0 point on E DSS) after the mobilisation, Two mobilisation failures were observed. No li fe-threatening events occurred during the transplantation. All grafted pati ents, except one, at least stabilised their disability status. One patient improved significantly (by 1.5 points on EDSS), two patients improved sligh tly (by 0.5 points on EDSS), one patient worsened by 1.0 point on the EDSS in 10 months, Improvement occurred with a delay of 2-4 months. Median EDSS and SNRS of grafted patients at the last follow up were 6.5 (5.5-8.5) and 6 4 (39-73), respectively with median follow-up of 8.5 months. Further follow -up is needed to determine the disease course after complete immune reconst itution.