Fingers crossed at AIIMS after stem cell transplant for Multiple Sclerosis, first in country

Doctors at the All India Institute of Medical Sciences (AIIMS) have conducted a stem cell transplant on a multiple sclerosis (MS) patient. They believe this is the first recorded case of an autologous stem cell therapy — where the donor and recipient are the same person — for MS in the country.  Six months after the transplant, doctors say the spread of MS, an autoimmune disease that affects the brain and spinal cord, appears to have been contained but the therapy cannot be declared a success until the patient is monitored for at least a year.

International trials have demonstrated that this transplant can restrict the spread of the disease in advanced patients, and may even reverse symptoms in early stages in some patients. Thirty-two-year-old Rohit Yadav, a commerce graduate from Delhi University, was diagnosed with the neurological disorder in 2010. In March this year, after trying all possible “conventional” treatment options, doctors at AIIMS finally decided on stem cell therapy.

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Dr Kameshwar Prasad, professor of neurology who has been monitoring Yadav, said: “The primary purpose of autologous stem cell transplant is to control the spread of lesions. We extract the patient’s own stem cells, treat and inject the stem cells back. Ever since the procedure, the patient has been completely stable. To the best of our knowledge, this is the first case of stem cell therapy for MS.”

In MS, the body’s own immune system attacks the myelin sheath that coats nerves, slowly destroying the central nervous system. Symptoms range from numbness and weakness in the limbs to sudden loss of balance and coordination, blurred vision and paralysis and, at the most advanced stage, disability. There is no known permanent cure. About a dozen injectible ‘disease-modifying drugs’ in the broad category of interferons are available in India to control symptoms. The only oral drug in the international market, Fingolimod, was put under restricted use by the US Food and Drug Administration (FDA) after the death of 11 patients earlier this year.

The procedure tried on Yadav has been under trial in the West, and is called autologous deceased haematopoietic stem cell transplantation. Yadav’s stem cells that generate body immunity were first extracted. He was put through a high-dose chemotherapy regimen to mitigate his faulty immune response system by destroying existing blood cells and the bone marrow which forms new blood cells. During this period, Yadav was kept in an isolation room to ensure he did not contract any infection. After this, his own stem cells were injected back into the body. These new stem cells again formed the bone marrow and all cells in the blood, creating a new immune response system which, doctors believe, will not have the faulty autoimmune tendency.

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Insisting that any improvement Yadav shows should be considered a “bonus”, doctors say his speech has become clearer.  “Earlier, there was so much slurring in his speech that when I would be on the phone with him, I couldn’t make out what he was saying. Now, after clinical evaluation, we find his speech is clearer,” Prasad said. Although doctors are still wary of commenting on any improvement in his motor abilities, Prasad points out that earlier a family member used to accompany Yadav to the hospital. But now, he comes to the hospital on his own.

But Prasad cautions against attributing any “magic solution” to stem cells. “A lot remains to be seen and observed. This is the first Indian MS patient who has had the stem cell transplant, so we need to see how he holds out in the long-term,” he said. Yadav told The Indian Express that what started as a slight limp in the left leg during his second year in college led to coordination problems in all four limbs. With time, he lost the ability to hold a pen and write.

”I tried everything. Not only interferon injections, considered standard therapy for MS, but everything that anyone recommended, be it ayurveda, unani or homoeopathy. I changed my diet, stayed in a cool environment. No matter what I did, each time I had a scan, doctors said the disease was worsening,” he said.

He read about stem cell therapy providing some hope to patients during trials in the West. “I had tried everything. This was the last option. I tried some private set-ups, but was not sure about their competence. At AIIMS, doctors were a little wary, given the risks associated with the long chemotherapy procedure, of contracting an infection after that.”  In 2011, doctors admitted him for a stem cell procedure. But he was discharged because close evaluation of the scans of his brain and spinal cord showed no new lesions in six months. “It was heart breaking to be admitted and then discharged. But there was no use hurrying the procedure,” he said.

A year later, new lesions were detected in his spinal cord, prompting doctors to admit him for the therapy. Fifty five days of hospital admission, with a week of chemotherapy to kill and build afresh his immune system, was not easy. “It was a challenging therapy, but I was prepared.”

Yadav works as a receptionist at the office of Vishwas, a Gurgaon-based non-profit organisation working for the differently-abled. ”I feel a noticeable change in my speech. I used to slur a lot. But I can speak much clearer now. More importantly, the MS has not spread since March,” he said.

News source: Deccan Chronicle



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