A Phase II Study of High Dose Chemotherapy With Autologous Hematopoietic Progenitor Cell Transplant for Multiple Sclerosis That Failed at Least Two Lines of Therapy

Date de début de l'étude : 1 novembre 2012

Inclusion Criteria: Age between 18-60, inclusive Patients carry a diagnosis of multiple sclerosis, according to the McDonald's criteria for diagnosis (Polman et al, 2011). Must have a neurologist providing the primary care for the MS and be willing to be evaluated for the multiple sclerosis by the two neurologists who are the co-investigators in the protocol. Must be documented to be HIV negative. An EDSS of 3.5 - 5.5 Patients must be able to give written consent. Inflammatory disease despite primary disease modifying therapy with at least 6 months of interferon and another disease modifying therapy, including fingolimod,glativamir, natalizumab, and mitoxantrone. Failure is defined as two or more clinical relapses with documented neurologic changes (excluding sensory changes) within the year prior to the study. (NOTE: Relapses must have required treatment with corticosteroids). Failure may also be defined as one relapse (excluding sensory changes) treated with methylprednisone and, on a separate occasion within the previous 12 months, evidence of active inflammation (i.e. gadolinium enhancement on MRI scan of the CNS). No previous history of allergic reaction to cyclophosphamide, G-CSF or mesna Patients must not be pregnant Failure to accept or comprehend irreversible sterility as a potential side effect of therapy. Life expectancy of more than 6 months No evidence of myelodysplastic syndrome on peripheral blood smear Not allergic to cyclophosphamide, mesna, fludarabine or alemtuzumab Baseline serum creatinine must be <1.5 mg/dL, left ventricular ejection fraction >55%, adequate pulmonary functions (oxygen saturation at room air of >90%), and AST and ALT not > 2x upper limits of normal, and no history of previous or active malignancy, except for localized cutaneous basal or squamous cell carcinoma in situ of the cervix. Exclusion Criteria: Diagnosis of primary progressive MS.