Magdalena Walicka1, Alicja Milczarczyk2, Emilian Snarski3, Krystyna Jedynasty4, Kazimierz Halaburda5, Tigran Torosian6, Elżbieta Urbanowska7, Małgorzata Król8, Wiesław Wiktor Jędrzejczak9, Edward Franek10. 1. Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1). Electronic address: m_walicka@wp.pl. 2. Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1). Electronic address: alicja.milczarczyk@cskmswia.pl. 3. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). 4. Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1). Electronic address: krystyna.jedynasty@cskmswia.pl. 5. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). Electronic address: khalab30@wp.pl. 6. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). Electronic address: tigran.torosian@dkms.pl. 7. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). Electronic address: lecznica@interia.pl. 8. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). Electronic address: mikrol65@interia.pl. 9. Department of Oncology and Haematology, Medical University of Warsaw, Ul. 02-097 Warsaw, 1a Banacha Street, Poland(2). Electronic address: wieslaw.jedrzejczak@wum.edu.pl. 10. Department of Internal Diseases, Endocrinology and Diabetology, Central Clinical Hospital of the Ministry of the Interior and Administration in Warsaw, Ul. 02-507 Warsaw, 137 Wołoska Street, Poland(1); Department of Human Epigenetics, Mossakowski Medical Research Centre Polish Academy of Sciences, Ul. 02-106 Warsaw, 5 Pawińskiego Street, Poland(3). Electronic address: edward.franek@cskmswia.pl.
Abstract
AIMS: To assess metabolic control in patients with newly diagnosed type 1 diabetes mellitus who underwent immunoablation followed by autologous peripheral blood stem cell transplantation (APBSCT) as a treatment of diabetes. METHODS: APBSCT was performed in 23 patients. Control group comprised 8 non-APBSCT patients in whom after diagnosis insulin therapy was initiated. Fasting plasma glucose, glycated hemoglobin, fasting and postprandial C-peptide were assessed in all subjects and continuous glucose monitoring was performed at 6th, 12th, 24th, 36th, 48th month after transplantation. The APBSCT group was observed for 72 months. RESULTS: Six months after the procedure, 22 of 23 transplant patients remained insulin-free, but after 6 years, there was only one APBSCT insulin-free patient. Good glycemic control was observed in all patients throughout the observation period, although fasting plasma glucose in control group was significantly higher in comparison with the both transplanted groups up to the 36th month. HbA1c values were significantly lower in the insulin-free group only at the 24th and 36th month. Fasting and postprandial C-peptide concentrations were higher in APBSCT group as compared with control group. The most serious adverse event was a fatal case of Pseudomonas aeruginosa sepsis. CONCLUSIONS: The effectiveness of APBSCT as a treatment for newly diagnosed DM1 seems to be limited in time. The metabolic control of APBSCT patients is similar to conventionally treated patients. The lower fasting plasma glucose and higher C-peptide achieved with APBSCT seem to not exceed the risks associated with the procedure.
AIMS: To assess metabolic control in patients with newly diagnosed type 1 diabetes mellitus who underwent immunoablation followed by autologous peripheral blood stem cell transplantation (APBSCT) as a treatment of diabetes. METHODS:APBSCT was performed in 23 patients. Control group comprised 8 non-APBSCTpatients in whom after diagnosis insulin therapy was initiated. Fasting plasma glucose, glycated hemoglobin, fasting and postprandial C-peptide were assessed in all subjects and continuous glucose monitoring was performed at 6th, 12th, 24th, 36th, 48th month after transplantation. The APBSCT group was observed for 72 months. RESULTS: Six months after the procedure, 22 of 23 transplant patients remained insulin-free, but after 6 years, there was only one APBSCT insulin-free patient. Good glycemic control was observed in all patients throughout the observation period, although fasting plasma glucose in control group was significantly higher in comparison with the both transplanted groups up to the 36th month. HbA1c values were significantly lower in the insulin-free group only at the 24th and 36th month. Fasting and postprandial C-peptide concentrations were higher in APBSCT group as compared with control group. The most serious adverse event was a fatal case of Pseudomonas aeruginosa sepsis. CONCLUSIONS: The effectiveness of APBSCT as a treatment for newly diagnosed DM1 seems to be limited in time. The metabolic control of APBSCTpatients is similar to conventionally treated patients. The lower fasting plasma glucose and higher C-peptide achieved with APBSCT seem to not exceed the risks associated with the procedure.
Authors: Ida Pastore; Emma Assi; Moufida Ben Nasr; Andrea Mario Bolla; Anna Maestroni; Vera Usuelli; Cristian Loretelli; Andy Joe Seelam; Ahmed Abdelsalam; Gian Vincenzo Zuccotti; Francesca D'Addio; Paolo Fiorina Journal: Front Immunol Date: 2021-07-09 Impact factor: 7.561