Autologous hematopoietic cell transplantation for treatment-refractory relapsing multiple sclerosis: Position statement from the american society for blood and marrow transplantation
Biology of blood and marrow transplantation : journal of the American Society for Blood and Marrow Transplantation. 2019
Multiple sclerosis (MS) is a chronic, disabling, immune-mediated, central nervous system demyelinating and degenerative disease. Approved disease modifying therapies may be incompletely effective in some patients with highly active relapsing disease and high risk of disability. Immunoablative or myeloablative therapy followed by autologous hematopoietic cell transplantation (AHCT) has been investigated in retrospective studies, clinical trials, and meta-analyses/systematic reviews as an approach to address this unmet clinical need. On behalf of the American Society for Blood and Bone Marrow Transplantation (ASBMT), a panel of experts in AHCT and MS convened to review available evidence and make recommendations on MS as an indication for AHCT. Review of recent literature identified eight retrospective studies, eight clinical trials, and three meta-analyses/systematic reviews. In aggregate, these studies indicate that AHCT is an efficacious and safe treatment for active relapsing forms of MS to prevent clinical relapses, MRI lesion activity, and disability worsening, and to reverse disability, without unexpected adverse events. Based on the available evidence, the ASBMT recommends that treatment-refractory relapsing MS with high risk of future disability be considered a "standard of care, clinical evidence available" indication for AHCT. Collaboration of neurologists with expertise in treating MS and transplant physicians with experience performing AHCT for autoimmune disease is crucial for appropriate patient selection and optimizing transplant procedures to improve patient outcomes. Transplant centers in the United States and Canada are strongly encouraged to report baseline and outcomes data on patients receiving AHCT for multiple sclerosis to the Center for International Blood and Marrow Transplant Research.
Local corticosteroid versus autologous blood injections in lateral epicondylitis: meta-analysis of randomized controlled trials
European Journal of Physical and Rehabilitation Medicine. 2016;53((3):):483-491.
BACKGROUND Lateral epicondylitis is a common painful elbow disorder. Several approaches to treatment have been proposed, with a local injection of corticosteroids being the most frequently used. Recent insights into the pathophysiology encouraged the introduction of autologous blood injections as an alternative treatment method. AIM: The aim of this meta-analysis is to summarize quantitatively the evidence regarding the efficacy of corticosteroids and autologous blood injections for treatment of pain in lateral epicondylitis. DESIGN Meta-analysis. SETTING Outpatient treatment. POPULATION Studies were considered eligible based on the following inclusion criteria: adult human, diagnosis of lateral epicondylitis, randomized controlled trials comparing corticosteroids versus autologous blood injections, pain assessment. Exclusion criteria were previous surgery for lateral epicondylitis or for other elbow disorders, concurrent treatment with drugs or physiotherapy, diagnosis of musculoskeletal systemic disorder. METHODS A systematic search of literature was performed according to PRISMA statement. Effect size of each included study was calculated and analyzed in a random-effects model. RESULTS Four studies, enrolling total of 218 patients (139 females and 79 males), were included in quantitative analysis. At 2 weeks there was a trend towards a reduction of VAS score in the corticosteroid group (WMD = 2.12 [95% CI: 4.38 to 0.14], P=0.07). No significant differences were recorded in the medium-term (4-12 weeks; WMD = 0.85 [95% CI: -0.44 to 2.15], P= 0.19) and long-term (24 weeks; WMD = 0.63 [95% CI: -2.40 to 3.66], P= 0.68) follow-up. CONCLUSIONS Few high-quality trials compare the efficacy of corticosteroid and autologous blood injections in the control of pain related to lateral epicondylitis. Available data indicate that corticosteroids tend to reduce VAS score in short-term follow-up, although these data are not statistically significant. No differences were recorded in the medium and long term. CLINICAL REHABILITATION IMPACT Contrary to popular opinion among medical professionals, and despite pathophysiological cues, the currently available data offer no support for the effectiveness of autologous blood injections in medium- and long- term follow-up. Further studies are necessary to establish which treatment has more impact on pain in lateral epicondylitis. These data could be then used as a basis for practical guidelines and new protocols of treatment.
Efficacy and safety of autologous blood products compared with corticosteroid injections in the treatment of lateral epicondylitis, a meta-analysis of randomized controlled trials
Pm & R : the Journal of Injury, Function, and Rehabilitation. 2016;8((8):):780-91
OBJECTIVE To compare the efficacy and safety between autologous blood products (ABPs) and corticosteroid injections (CSIs) in the treatment of lateral epicondylitis (LE). TYPE Meta-analysis. LITERATURE SURVEY We systematically searched the EMBASE, PubMed, the Cochrane Library and Web of Science to identify randomized controlled trials (RCTs) comparing ABPs versus CSIs for the treatment of LE without language and publication date restriction through April 2015. METHODOLOGY Two investigators independently included and assessed the quality of each eligible study according to the method recommended by the Cochrane Collaboration. Available data about the main outcomes were extracted from each study and heterogeneity was assessed using the Q statistic and the inconsistency index (I2). We also evaluated the publication bias and conducted a subgroup analysis. The Review Manager 5.2 software was used for data syntheses and analyses, the standardized mean difference (SMD) or mean difference (MD) were estimated by using random effects models with 95% confidence interval (CI). To investigate the efficacy among different trial durations, the follow-up times were therefore divided into short (2-4 weeks), intermediate (6-24 weeks) and long term (≥ 24 weeks). SYNTHESIS Ten RCTs (n = 509) were included in this meta-analysis. The pooled analysis showed that CSIs were more effective than ABPs on pain relief (SMD = 0.88; 95% CI = 0.31to1.46%; P = .003) in the short term. However, in the intermediate term, ABPs exhibited a better therapeutic effect for pain relief (SMD = -0.38; 95% CI = -0.70 to -0.07%; P = .02), function (SMD = -0.60; 95% CI = -1.13 to -0.08%; P = .03), DASH (MD = -11.04; 95% CI = -21.72 to -0.36%; P = .04), and Nirschl stage (MD = -0.81; 95% CI = -1.11 to -0.51%; P < .0001). In the long term, ABPs were superior to CSIs for pain relief (SMD = -0.94; 95% CI = -1.32 to -0.57%; P < .0001) and Nirschl stage (MD = -1.04; 95% CI = -1.66 to -0.42%; P = .001). Moreover, for grip strength recovery, there was no significant difference between the two therapies (p > .05). CONCLUSIONS There was limited evidence supporting the conclusion that CSIs were superior to ABPs for pain relief in the short term; however, this result was reversed in the intermediate and long term. ABPs seemed to be more effective at restoring function in the intermediate term. Due to the small sample size and the limited number of high-quality RCTs, more high-quality RCTs with large sample sizes are required to further validate this result.
Autologous whole blood or corticosteroid injections for the treatment of epicondylopathy and plantar fasciopathy? A systematic review and meta-analysis of randomized controlled trials
Physical Therapy in Sport : Official Journal of the Association of Chartered Physiotherapists in Sports Medicine. 2016;22:114-122
OBJECTIVES To compare the efficacy of autologous whole blood with that of corticosteroid injections on epicondylopathy and plantar fasciopathy. DESIGN Systematic review and meta-analysis. METHODS The databases of PubMed, Web of Science, CENTRAL, and Scopus were searched up to 6th May 2015. Randomized trials comparing the effects of autologous whole blood and corticosteroid injections on epicondylopathy or plantar fasciopathy were included. Trials exploring the efficacy of platelet-rich plasma were excluded. The primary outcome was pain relief. The secondary outcome included the assessment of composite outcomes. All outcomes were assessed at 2-6 (short-term) weeks, 8-13 (intermediate-term) weeks and 24-26 (medium-term) weeks. Quality assessment was performed with the Cochrane risk of bias tool. RESULTS Nine trials were included. For pain relief, there was a statistically significant difference in favour of corticosteroids in the short term (SMD 0.52; 95%CIs 0.18 to 0.86; I2 = 53%; p < 0.01). A statistically significant difference in favour of autologous whole blood was indicated in the medium-term assessment of pain relief on epicondylopathy. CONCLUSIONS Corticosteroids were marginally superior to autologous whole blood in relieving pain on plantar fasciopathy at 2-6 weeks. Autologous whole blood provided significant clinical relief on epicondylopathy at 8-24 weeks. Conclusions were limited by the risk of bias.