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462 Chapter 8: Autoimmune Disease<br />

TBI (1200 cGy) for conditioning, which was well tolerated, <strong>and</strong> ex vivo T<br />

cell-depleted grafts. Functional improvement occurred in all three patients.<br />

AutoSCT cannot possibly provide definite cure of MS. Three of our patients<br />

continued to deteriorate <strong>and</strong>, on MRI analysis, four new active lesions were found to<br />

have developed in two patients who had evidence of active MRI lesions at<br />

enrollment. However, it seems that autoSCT may induce prolonged stabilization, or<br />

may bring the disease to a lower level of activity, in the four patients who had disease<br />

flares without generalized progression. Longer follow-up of the patients is necessary,<br />

not only to confirm any beneficial effect but also to determine long-term toxicity. At<br />

present, it would seem reasonable to conclude that autoSCT in MS warrants further<br />

study, with well-designed phase II <strong>and</strong>, eventually, comparative trials.<br />

REFERENCES<br />

1. Matthews WB: Course <strong>and</strong> prognosis. In: Matthews WB, Compston A, Allen IV, Martyn<br />

CN (eds) McAlpines's Multiple Sclerosis, 2nd ed. Singapore: Churchill Livingstone,<br />

1991, p. 139-163.<br />

2. Rudich R, Cohen JA, Weinstock-Guttman B, et al.: Management of multiple sclerosis. N<br />

Engl J Med 337:1604-1611, 1997.<br />

3. Marmont AM, van Bekkum DW: Stem cell <strong>transplantation</strong> for severe autoimmune diseases.<br />

Bone Marrow Transplant 16:497-498, 1995.<br />

4. Snowden JA, Brooks PM, Biggs JC: Haemopoietic stem cell <strong>transplantation</strong> for autoimmune<br />

diseases. Br J Haematol 99:9-22, 1997.<br />

5. van Gelder M, van Bekkum DW: Treatment of relapsing experimental autoimmune<br />

encephalomyelitis in rats with allogeneic bone <strong>marrow</strong> <strong>transplantation</strong> from a resistant<br />

strain. Bone Marrow Transplant 16:343-351, 1995.<br />

6. Karussis DM, Vourka-Karussis U, Lehmann D, et al.: Prevention <strong>and</strong> reversal of adop­<br />

tively transferred, chronic relapsing experimental autoimmune encephalomyelitis with a<br />

single high dose cytoreductive treatment followed by syngeneic bone <strong>marrow</strong> transplan­<br />

tation. J Clin Invest 92:765-772, 1993.<br />

7. van Gelder M, Kinwell-Bohre EPM, van Bekkum DW: Treatment of experimental aller­<br />

gic encephalomyelitis in rats with total body irradiation <strong>and</strong> syngeneic BMT. Bone<br />

Marrow Transplant 11:233-241, 1993.<br />

8. van Gelder M, van Bekkum DW: Effective treatment of relapsing experimental autoim­<br />

mune encephalomyelitis with pseudo<strong>autologous</strong> bone <strong>marrow</strong> <strong>transplantation</strong>. Bone<br />

Marrow Transplant 18:1029-1034, 1996.<br />

9. Snowden JA, Patton WN, O'Donnell J, et al.: Prolonged remission of longst<strong>and</strong>ing systemic<br />

lupus erythematosus following <strong>autologous</strong> bone <strong>marrow</strong> <strong>transplantation</strong> for non-<br />

Hodgkin's lymphoma. Bone Marrow Transplant 19:1247-1250, 1997.<br />

10. Euler HH, Marmont AM, Bacigalupo A, et al.: Early recurrence or persistence of autoimmune<br />

diseases after unmanipulated <strong>autologous</strong> stem cell <strong>transplantation</strong>. Blood<br />

88:3621-3625, 1996.<br />

11. Slavin S, Karussis D, Weiss L, et al.: Immunohematopoietic reconstitution by allogène-

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