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Published in: Journal of Neurology 1/2021

Open Access 01-01-2021 | Stem Cell Transplantation | Original Communication

Autologous haematopoietic stem cell transplantation for refractory stiff-person syndrome: the UK experience

Authors: Lewis Kass-Iliyya, John A. Snowden, Alice Thorpe, Helen Jessop, Andrew D. Chantry, Ptolemaios G. Sarrigiannis, Marios Hadjivassiliou, Basil Sharrack

Published in: Journal of Neurology | Issue 1/2021

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Abstract

Stiff Person Syndrome (SPS) is a rare immune-mediated disabling neurological disorder characterised by muscle spasms and high GAD antibodies. There are only a few case reports of autologous haematopoietic stem cell transplantation (auto-HSCT) as a treatment for SPS.

Objective

To describe the UK experience of treating refractory SPS with auto-HSCT.

Methods

Between 2015 and 2019, 10 patients with SPS were referred to our institution for consideration of auto-HSCT. Eight patients were deemed suitable for autograft and four were treated. Of the treated patients, three had classical SPS and one had the progressive encephalomyelitis with rigidity and myoclonus variant. All patients were significantly disabled and had failed conventional immunosuppressive therapy. Patients were mobilised with Cyclophosphamide (Cy) 2 g/m2 + G-CSF and conditioned with Cy 200 mg/kg + ATG followed by auto-HSCT.

Results

Despite their significantly reduced performance status, all patients tolerated the procedure with no unexpected toxicities. Following autograft, all patients improved symptomatically and stopped all forms of immunosuppressive therapies. Two patients were able to ambulate independently from being wheelchair dependent. One patient’s walking distance improved from 300 meters to 5 miles and one patient’s ambulation improved from being confined to a wheelchair to be able to walk with a frame. Two patients became seronegative for anti-GAD antibodies and normalised their neurophysiological abnormalities.

Conclusions

Auto-HSCT is an intensive but well tolerated and effective treatment option for patients with SPS refractory to conventional immunotherapy. Further work is warranted to optimise patient selection and establish the efficacy, long-term safety, and cost-effectiveness of this treatment.
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Metadata
Title
Autologous haematopoietic stem cell transplantation for refractory stiff-person syndrome: the UK experience
Authors
Lewis Kass-Iliyya
John A. Snowden
Alice Thorpe
Helen Jessop
Andrew D. Chantry
Ptolemaios G. Sarrigiannis
Marios Hadjivassiliou
Basil Sharrack
Publication date
01-01-2021
Publisher
Springer Berlin Heidelberg
Published in
Journal of Neurology / Issue 1/2021
Print ISSN: 0340-5354
Electronic ISSN: 1432-1459
DOI
https://doi.org/10.1007/s00415-020-10054-8

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