Maximizing Outcome of Multiple Sclerosis Transplantation

Inclusion Criteria:

1. Age between 18-58 years

2. Diagnosis of MS using revised McDonald criteria of clinically definite MS (Appendix A)

3. An EDSS score of 2.0 to 6.0 (Appendix B).

4. An EDSS >6.0 may be included if still relapsing-remitting disease and at least two
enhancing lesions on MRI within the last three months

5. Inflammatory disease despite treatment with standard disease modifying therapy (DMT)
including at least 6 months of interferon or Copaxone. Inflammatory disease is defined
based on either MRI (gadolinium enhancing lesion, new T2 lesion) or *steroid-treated
clinical relapses (prescribed by a neurologist)

6. Minimum disease activity required:

1. Failed a first line DMT (Copaxone or Interferon), defined as two or more *steroid
treated clinical relapses within the last 12 months. A clinical relapse may also
be evidence of active inflammation on MRI (gadolinium enhancing lesion or new T2
lesion) in the last 12 months on two MRIs at least three months apart

2. Failed a second or third line MS Drug: Zinbryta (daclizumab), Aubagio
(teriflunomide), Gilenya (fingolimod), Tecifidera (dimethyl fumarate), Lemtrada
(alemtuzumab), Ocrevus (ocrelizumab), Tysabri (natalizumab), Rituxan (rituximab)
or IVIg, defined as one *steroid treated clinical relapse within the last 12
months or evidence of active inflammation on MRI (gadolinium enhancing lesion or
new T2 lesion) in the last 12 months.

3. Cognitive dysfunction that prevents gainful employment, but competent to comply
with treatment and informed consent

- A steroid-treated relapse will include a relapse that was severe enough to
justify treatment but due to patient intolerance of steroids, they were
offered but not used.

Exclusion Criteria:

1. Any adult who is unable to consent (for adults who are cognitively impaired due to MS,
consent may be obtained from the closest living relative or person who has power of
attorney)

2. Individuals under the age of 18 or over the age of 58

3. Diagnosis of Primary Progressive MS, Secondary Progressive MS, or Clinically Isolated
Syndrome (CIS)

4. Pregnant women (positive serum or urine human chorionic gonadotropin (HCG) test)

5. Women who are breastfeeding

6. Prisoners

7. Any illness that in the opinion of the investigators would jeopardize the ability of
the patient to tolerate aggressive chemotherapy

8. Prior history of malignancy except localized basal cell, squamous skin cancer or
carcinoma in situ of the cervix

9. Any prior chemotherapy or radiation therapy (except for cyclophosphamide used to treat
MS disease)

10. History of sickle cell disease (SS), SC disease, coagulopathy, or if actively
receiving anticoagulation therapy

11. History of insulin-dependent diabetes

12. Inability or unwillingness to pursue effective means of birth control from the time of
evaluation for eligibility until 6 months post-transplant. Effective birth control is
defined as (1) abstinence defined as refraining from all acts of vaginal intercourse,
(2) consistent use of birth control pills, (3) injectable birth control methods
(Depo-provera, Norplant), (4) tubal sterilization or male partner who has undergone
vasectomy, (5) placement of an intrauterine device (IUD), or (6) with every act of
intercourse, use of diaphragm with contraceptive jelly and/or use of condom with
contraceptive foam

13. Failure to willingly accept or comprehend irreversible sterility as a side effect of
therapy

14. Forced expiratory volume at one second (FEV1)/ forced vital capacity (FVC) < 60% of
predicted after bronchodilator therapy (if necessary)

15. Diffusing capacity of the lungs for carbon monoxide (DLCO) < 60% of predicted

16. Resting left ventricular ejection fraction (LVEF) < 50 %

17. Bilirubin > 2.0 mg/dl

18. Serum creatinine > 2.0 mg/dl

19. Known hypersensitivity to mouse, rabbit, or E. Coli derived proteins or to iron
compounds/medications

20. Presence of metallic objects implanted in the body that would preclude the ability of
the patient to safely have MRI exams

21. Platelet count < 100,000/ul

22. White blood cell count (WBC) < 1,500 cells/mm3

23. Psychiatric illness, mental deficiency or cognitive dysfunction making compliance with
treatment or informed consent impossible

24. Active infection except asymptomatic bacteriuria

25. Use of Tysabri (natalizumab) within the previous six months

26. Use of Gilenya (fingolimod) within the previous three months

27. Use of Tecfidera (dimethyl fumarate) within the previous three months

28. Use of Aubagio (teriflunomide) unless cleared from the body (plasma concentration
<0.02mcg/ml) following elimination from the body with cholestyramine 8g three times a
day for 11 days

29. Use of Lemtrada/Campath (alemtuzumab) within previous 12 months

30. Use of Rituxan (rituximab) or Ocrevus (ocrelizumab) within previous four months

31. Prior treatment with Novantrone (mitoxantrone)

32. Any hereditary neurological disease such as Charcot-Marie-Tooth disease (CMT),
Spinocerebellar ataxia (SCA), or Parkinson's Disease

33. Severe or symptomatic cervical spinal stenosis unless surgically corrected

34. Myocardial infarction within last 12 months; if longer than 12 months, must pass
dobutamine stress test and be cleared by cardiology