Dear Collegues working in the field of bone marrow transplantation,
Could anyone with experience suggest protocol of conditioning regimen for multiple sclerosis and systemic scleroderma before autologous stem cell transplantation.
Aim:
1. Low (to zero) treatment related mortality
2. Most beneficial results
Thank You in advance.
To my knowledge the so-called "BEAM" (best mortality:effectiveness ratio)
The "light" is safer, but less effective
The optimal conditioning regimen for autologous HSCT in systemic sclerosis is unknown. The regimen used in ASTIS trial is a combination of cyclophosphamide (200 mg/kg) and rATG, an immunoablative regimen. TBI has shown to increase morbidity of the HDCT. By decreasing cyclophosphamide dose during conditioning regimen might decrease the efficacy. In ASTIS trial included CD34+ cell selection was done which is of unknown benefit or risk.
Cardiopulmonary evaluation will determine the mortality risk apart from the conditioning.
Do consider maintenance therapy with MMF.
There is a good editorial about it.
Here is the link.
http://jama.jamanetwork.com/article.aspx?articleid=1882991
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