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Review
. 2023 Nov 16;86(1):421-432.
doi: 10.1097/MS9.0000000000001490. eCollection 2024 Jan.

Immunological outcomes of autologous hematopoietic stem cell transplantation for multiple sclerosis: a systematic review

Alla Sai Santhosha Mrudula  1 , Naga L P Avula  2 , Sanah Kauser Ahmed  3 , Rishabh B Salian  4 , Deekshitha Alla  1 , Preethi Jagannath  5 , Sri S S P Polasu  5 , Pranathi Rudra  6 , Yussif Issaka  7 , Moksh S Khetan  8 , Trisha Gupta  9
Affiliations
Review

Immunological outcomes of autologous hematopoietic stem cell transplantation for multiple sclerosis: a systematic review

Alla Sai Santhosha Mrudula et al. Ann Med Surg (Lond). .

Abstract

Background: Autologous hematopoietic stem cell transplantation (AHSCT) is an extensive procedure that allows for the depletion of the immune system and its restoration from hemopoietic stem cells. The approach has been modified for the treatment of severe immune-mediated illnesses, including multiple sclerosis (MS), after being initially devised for the treatment of hematological malignancies.

Objective: This systematic review aims to determine and consolidate the information on the short-term and long-term immunological effects of AHSCT on the cellular level in MS patients.

Methods: The PubMed, Scopus, and Web of Science servers were used to conduct a systematic search in compliance with the PRISMA guidelines. The results were tabulated and analyzed.

Results: A total of 17 studies (10 clinical trials, 6 cohort studies, and 1 case-control study) were included in the final analysis, and 383 MS patients were analyzed. A significant decline in the cell count of CD4 T cells was reported when compared to the CD8 T cells, B cells, and NK cells. B cell count returned to baseline in 71.4% of the studies at the end of 6 months. The NK cell count was found to be above the baseline in 62.5% of studies.

Conclusion: AHSCT has been proven to be one of the most effective treatment modalities for MS in recent studies. However, debilitating complications due to immunological outcomes of the procedure have led to increased morbidity. Further research into this domain will help boost the success rate and efficacy of AHSCT.

Keywords: autoimmune disorders; autologous hemopoietic stem cell transplant; immune cells; multiple sclerosis; myeloablation.

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Conflict of interest statement

None.Sponsorships or competing interests that may be relevant to content are disclosed at the end of this article.

Figures

Figure 1
Figure 1
PRISMA flowchart depicting the screened articles. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.
Figure 2
Figure 2
Image depicting the time taken by different immune cells to reach baseline after AHSCT. B cells, NK cells, CD8 central memory cells, CD8 effector memory cells, total CD8 cells, CD4 effector memory cells, and T regulatory cells returned to baseline by 2–6 months. CD8 naive cells and CD4 naive cells returned to baseline by 1 year. Total CD4 cells returned to baseline by 2 years. AHSCT, autologous hematopoietic stem cell transplantation.
See this image and copyright information in PMC

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