LA TERAPIA CELULAR LOGRA EL CONTROL DE LA ESCLEROSIS MÚLTIPLE A TRES AÑOS
Los pacientes presentaron mejoras neurológicas aunque algunos expertos advierten sobre la agresividad del tratamiento y sus efectos adversos
Tres años después de recibir un trasplante de células madre, un pequeño número de pacientes con un tipo determinado de esclerosis múltiple (EM), la esclerosis múltiple con recaída-remisión, permanecen libres de recaídas de la enfermedad y con mejoras en su función neurológico. Los pacientes fueron tratados con una terapia inmunosupresora de altas dosis y posteriormente recibieron un trasplante con sus propias células madre hematopoyéticas. El estudio se publica en «Archives of Neurology» y abre la puerta al empleo de esta vía como una opción terapéutica para estos pacientes aunque algunos investigadores cuestionan tanto la eficacia a largo de la terapia como su seguridad. La EM es una enfermedad degenerativa y se ha visto que la mayoría de los pacientes con esclerosis múltiple con recaída-remisión que han recibido terapias modificadoras experimentan una mejora significativa. En cuanto al trasplante autólogo de células hematopoyéticas (usando las propias células de un paciente) tiene como objetivo eliminar las células inmunes que causan la enfermedad y restablecer el sistema inmune. El artículo de Richard A. Nash, del Instituto Colorado Blood Cancer Institute at Presbyterian/St. Luke’s Medical Center (EE.UU.), presenta los datos a tres años de esta intervención terapéutica, aunque el seguimiento es ya de 5 años. Y los resultados muestran que de los 24 pacientes que recibieron el tratamiento, la tasa global de supervivencia libre de eventos (definida como supervivencia sin muerte o enfermedad con pérdida de la función neurológica, recaída clínica o nuevas lesiones), era del 78,4% a los tres años.
Terapia agresiva
No obstante los autores señalan que los eventos adversos fueron los esperados con los efectos tóxicos de este tratamiento tan agresivo. Pero por otro lado se observaron mejoras en la discapacidad neurológica, en la calidad de vida y en las puntuaciones funcionales. «El estudio confirma la remisión de actividad de la EM de hasta tres años en la mayoría de los participantes. Por tanto –sostienen los investigadores- puede representar una opción terapéutica para los pacientes con esclerosis múltiple en los que la inmunoterapia convencional falla, así como para otras patologías inmunes graves en las que interviene el sistema nervioso central». Y en cuanto a los efectos adversos, señalan, «la mayoría de los efectos eran hematológicos y gastrointestinales, aunque reversibles». Por último reconoce que hace falta un seguimiento a más largo plazo para determinar la sostenibilidad de la respuesta.
Con reparos
Sin embargo, en un editorial M. Mateo Paz Soldán, de la Universidad de Utah-Salt Lake City, y Brian G. Weinshenker, de la Clínica Mayo, reconocen que tanto este estudio y como otro de fase 2 dejan pocas dudas de que la terapia con altas dosis de inmunoterapia es capaz de suprimir actividad de la enfermedad inflamatoria en pacientes con EM que tienen la enfermedad activa en el corto plazo. Pero advierten que aunque se ha aprendido mucho sobre cómo se pueden reducir la morbilidad y mortalidad relacionada con el tratamiento «se han producido muertes, incluso en estudios pequeños, y los regímenes agresivos se han traducido en la aparición de linfomas asociados con el virus de Epstein-Barr».
Fte: abc.es
http://www.abc.es/salud/noticias/20141230/abci-esclerosis-multiple-terapia-201412291843.html
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