Questionnaire

APPLICATION FOR TREATMENT

(AHSCT)
ELIGIBILITY

CRITERIA

FOR TREATMENT WITH STEM CELL TRANSPLANTATION
Inclusion Criteria
        Acceptable criteria for treatment:

        • Age 16 – 70 years old
        • Absence of severe chronic infections
        • Negative serology HBV, HCV, HIV
        • Absence of mental and cognitive deficits and ability to provide informed consent
        • Absence of gross cognitive disturbances
        • Absence of severe concomitant diseases

        Systemic autoimmune diseases:


        • Diagnosed Multiple Sclerosis with EDSS between 1.5 and 6.5 (documented progression/relapses over the previous year, with or without gadolinium-enhancing lesions).
        • Chronic Inflammatory Demyelinating Polyneuropathy (CIDP)
        • Severe systemic vasculitis
        • Systemic lupus erythematosus
        • Systemic sclerosis
        • Crohn's disease
        • Other severe systemic autoimmune conditions, including connective tissue diseases

        Adequate organ function:


        • Cardiac LV Ejection Fraction >45%
        • Total Lung capacity > 60%
        • Pulmonary artery pressure < 45 mmHg
        • DLCO/VA>50%
                        Exclusion Criteria

                        List of contraindications for treatment
                        :

                        • A positive test for HIV, Hepatitis B and Hepatitis C.
                        • Severe extensive or prolonged infection caused by viruses, fungi and bacteria.
                        • Uncontrolled diabetes.
                        • Evidence myelodysplasia or other non-autoimmune cytopenia.
                        • Having received a cytotoxic agent within one month prior to AHSCT.
                        • Pregnancy or at risk of pregnancy, including those unwilling to practice active contraception during the time of therapy.
                        • Psychiatric illness, mental deficiency, or gross cognitive dysfunction.
                        • Inability to give written and informed consent in accordance with world ethics guidelines for medical treatment.
                        • High disability level of MS patient

                        Any condition, obstructing the normal functioning of the main organs

                        (Heart, Kidneys, Lung, Liver etc.)
                        - As this would limit your ability to receive high-dose immunosuppressive therapy
                        with Autologous Hematopoietic Stem Cell Transplantation.
                              Please, try to be objective...
                              Despite the results of the questionnaire review, the final decision of approvement for treatment will be based on the results of a pre - transplant examination in Moscow.