Autologna transplantacija matičnih ćelija u kombinaciji sa imunoablativnim protokolom kod sekundarne progresivne multiple skleroze – 10 godina praćenja prvog transplantiranog bolesnika

  • Dragana Obradović Clinic of Neurology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Ljiljana Tukić Clinic of Hematology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Sanja Radovinović-Tasić Institute of Radiology,Military Medical Academy, Belgrade, Serbia
  • Boris Petrović Diagnostic Center VAMED-VMR, Novi Sad, Serbia
  • Marija Elez Clinic of Hematology,Military Medical Academy, Belgrade, Serbia
  • Gordana Ostojić Institute of Transfusiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
  • Bela Balint Institute of Transfusiology, Military Medical Academy, Belgrade, Serbia; Faculty of Medicine of the Military Medical Academy, University of Defence, Belgrade, Serbia
DOI: https://doi.org/10.2298/VSP150304045O
Ključne reči: multiple sclerosis, chronic progressive||, ||multipla skleroza, hronična, progresivna, hematopoietic stem cell transplantation||, ||transplantacija hematopoeznih matičnih ćelija, transplantation, autologous||, ||transplantacija, autologna, treatment outcome||, ||lečenje, ishod, magnetic resonance imaging||, ||magnetna rezonanca, snimanje,

Sažetak


Uvod. Multipla skleroza (MS) je imunski posredovana bolest centralnog nervnog sistema koja ugrožava mladu populaciju i dovodi do teških invaliditeta. Imunoablativna terapija u kombinaciji sa autolognom hematopoetskom transplantacijom matične ćelije (ATMĆ) poslednjih 15 godina smatra se potencijalno efikasnim terapeutskim pristupom za agresivnu formu MS. Najnoviji rezultati dugotrajnog praćenja pokazuju da ATMĆ nije efikasna samo za visokoagresivnu MS, već i za relapsno-remitentni oblik MS, obezbeđujući dugotrajnu remisiju, možda čak i izlečenje. Prikazali smo rezultate 10-godišnjeg praćenja prvog bolesnika sa MS koji je lečen imunoablativnom terapijom i ATMĆ. Prikaz bolesnika. Bolesnik, star 27 godina, imao je prve simptome – povremenu ukočenost i parestezije ruku i nogu, zbog kojih je tokom dve godine lečen kod psihijatara pod dijagnozom anksiozni poremećaj. Zbog teške parapareze primljen je na Kliniku za neurologiju, gde je dijagnostikovana MS. Prikazani bolesnik oboleo je od agresivnog oblika MS sa čestim relapsima. Invaliditet je brzo napredovao i nakon šest godina od početka bolesti nastupio je prelazak u sekundarno progresivni oblik: proširena skala funkcionalne onesposobljenosti (EDSS) 7.0, Ambulation Index (AI) 7. Urađena je ATMĆ. Korišćen je ciklofosfamid za mobilizaciju matičnih ćelija iz krvi, a BEAM protokol kao kondicioni režim. Nije bilo značajnijih neželjenih dejstava tokom i nakon ATMĆ. Došlo je do poboljšanja neurološkog deficita. Skor EDSS bio je 6.5, AI 6 i tokom 10 godina praćenja ostao je nepromenjen.
Zaključak. Kod prikazanog bolesnika sa agresivnom, neinflamatornom MS, nakon ATMĆ došlo je do poboljšanja neurološkog deficita i odsustva dalje progresije narednih 10 godina. Ovu vrstu lečenja treba razmotriti kod agresivne MS, jer na vreme urađena ATMĆ može ne samo da spreči napredovanje invaliditeta, već i da redukuje neurološki deficit.


 

 

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Objavljeno
2017/03/07
Broj časopisa
Vol. 73 Br. 5 (2016)
Rubrika
Prikaz bolesnika