Maximov’s Department of Hematology and Cell Therapy at the National Pirogov Medical Surgical Center specializes in the modern treatment of hematological, oncological and autoimmune diseases. Hospitality standards and quality of medical care in the department are at least equivalent to those of the leading American and Western European medical centers.
Particularly interesting for our foreign guests is an innovative technology of high-dose immunosuppressive therapy with hematopoietic stem cell transplantation in autoimmune diseases.
Experience of the National Surgical Center Pirogov in the ASHCT –
Efficacy and toxicity (for MS).
The experience of the National Surgical Center in Pirogov in the area ASHCT for
MS patients is the greatest experience of a single center in the world. The analysis
a fairly large cohort of patients (more than 200 MS patients) with different
Types of disease courses were performed. The core findings of this study will be
shown below. It has been shown that the transplant procedure of the
Patients were well tolerated and no transplant-related deaths occurred.
Remarkably, in this group were throughout the
Follow-up time no deaths registered. The most important early side effects
were feverish neutropenia (31.6%), mild and moderate liver toxicity (42.1%),
transient neurological worsening (27.4%), diarrhea (7.4%), sepsis (3.2%),
Bleeding (3.2%), viral infections (2.1%), pneumonia (2.1%), fungal infection (1%),
Rash / allergy (8.4%). Long-term side effects were fatigue (2-3 months
after AHSCT) and alopecia (4-5 months after AHST). All side effects were
predictable and controlled. The cumulative incidence of disease progression
was 16.7% 8 years after the AHSCT. The estimated event-free survival at one
median follow-up of 48.9 months was 80%. These promising results
could be due to the fact that our patient group was relatively young
(Average age – 35 years) and not very handicapped (median EDSS – 3.5). This
agrees with the proposal that the best candidate for a transplant
relatively young patients with active inflammatory lesions of relatively short duration and
seem to be progressing rapidly, but they are still low
Number of disabilities that are resistant to conventional therapy.
The advantage of our study is that we have patients with different MS types
have included. It has been shown that AHSCT in patients with both
recurrent remission (RRMS) as well as with progression progression (PrMS) of the
Illness can be effective. The cumulative frequency of disease progression
was quite low for both RRMS and PrMS. She was with patients
progressive disease progression higher than in patients with relapsing-remitting MS:
21.3% vs. 13.2%. For the long-term follow-up (median 48.9 months) was the event-free
Survival rate in the group with RRMS 83.3% and in the group with progressive course
75.5%. Our results are comparable to the international experience.
Remarkably, all patients without disease progression were during the
Post-transplant phase out of therapy. Another benefit of our study is that we
both patients with active CNS disease (40%) and before transplantation
have included. The latter had no active lesions on the MRI, they learned
however, a clinical worsening and progression of disability. It was
demonstrated that both patients with active CNS disease and those without
Transplantation can benefit from a transplant. This can be done by the
Presence of occult inflammation can not be explained with conventional MRI
is detectable. In this situation we think it possible that the neurological
Progression may be indicative of AHSCT even in the absence of active lesions.
In addition to the clinical results, we examined the patient reported
Results, namely changes in quality of life (QoL) according to the AHSCT. The
Quality of life is an important outcome of MS treatment, and its assessment provides the
Perspective of the patient on the overall effect of the treatment and allows the
Evaluation of patient benefit. Our results clearly show that AHSCT becomes a
significantly improving the quality of life of patients. In the
Long-term follow-up showed improvement for both the RRMS group
as well as for the patients as the disease progresses.