***TASK*** the task is to summarize an input biomedical literature in six sentences 
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    Input: High-dose immunosuppressive therapy ( HDIT ) with autologous hematopoietic stem cell transplantation ( auto-HSCT ) is a new and promising approach to the treatment of multiple sclerosis ( MS ) patients because currently there are no effective treatment methods for this disease . In this article , we present results of a prospect i ve clinical study of efficacy of HDIT + auto-HSCT in MS patients . The following treatment strategies were employed in the study : " early , " " conventional , " and " salvage/late " transplantation .  Fifty patients with various types of MS were included in this study . No toxic deaths were reported among 50 MS patients ; transplantation procedure was well-tolerated by the patients . The efficacy analysis was performed in 45 patients . Twenty-eight patients achieved an objective improvement of neurological symptoms , defined as at least 0.5-point decrease in the Exp and ed Disability Status Scale ( EDSS ) score as compared to the baseline and confirmed during 6 months , and 17 patients had disease stabilization ( steady EDSS level as compared to the baseline and confirmed during 6 months ) . The progression-free survival at 6 years after HDIT + auto-HSCT was 72 % . Magnetic resonance imaging data were available in 37 patients before transplantation showing disease activity in 43.3 % . No active , new , or enlarging lesions were registered in patients without disease progression . In conclusion , HDIT + auto-HSCT suggests positive results in management of patients with different types of MS .  Identification of treatment strategies based on the level of disability , namely " early , " " conventional , " and " salvage/late " transplantation , appears to be feasible to improve treatment outcomes Based on the good results of experimental transplantation in animal models of multiple sclerosis and of other autoimmune diseases , we have treated 24 patients suffering from chronic progressive multiple sclerosis with high-dose chemotherapy ( BEAM regimen ) followed by autologous blood stem cell rescue and antithymocyte globulin . Blood stem cells were mobilised with cyclophosphamide at 4g/m2 and G- ( or GM- ) CSF . In 9 cases , additional CD34 + cell- selection of the graft was performed . Here we up date previously published results of this novel treatment , mainly with regard to clinical efficacy , as the median follow-up time has reached 40 months ( range , 21–51 ) . Infections were the principal toxicity early after the procedure , with death of a patient from aspergillosis 65 days post stem cell infusion . No serious late events occurred apart from a case of autoimmune thyroiditis that developed 11 months after transplant in a patient who had received a CD34 + cell-depleted graft . Mild and transient neurotoxicity was observed in 10 patients ( 42 % ) , most probably associated with fever and infections . Eighteen patients ( 18/23 ; 78 % ) responded to the treatment , i.e. , they were improved or stabilized , while five patients progressed , of which 4 had primary progressive disease . Of those improved or stabilised ( 18 ) , 9 patients have maintained stable condition whereas 9 developed relapses or they slowly resumed progression , although their disability scores have not gotten worse than they were before transplantation . The probability of progression-free survival ( compared to entry status ) at 3 years is 92 % for patients with secondary progressive disease and 39 % for the primary progressive type . CD34 + cell- selection did not seem to yield better results except for a delay in progression or in relapse after transplantation . These results appear better than those achieved by any other treatment of progressive multiple sclerosis , including beta-interferon , but they need to be confirmed by other open or controlled studies in view of the well-known difficulty of judging objective ly the effect of a treatment in patients with this disease There were 26 patients enrolled in a pilot study of high-dose immunosuppressive therapy ( HDIT ) for severe multiple sclerosis ( MS ) . Median baseline exp and ed disability status scale ( EDSS ) was 7.0 ( range , 5.0 - 8.0 ) . HDIT consisted of total body irradiation , cyclophosphamide , and antithymocyte globulin ( ATG ) and was followed by transplantation of autologous , granulocyte colony-stimulating factor (G-CSF)-mobilized CD34-selected stem cells .  Regimen-related toxicities were mild . Because of bladder dysfunction , there were 8 infectious events of the lower urinary tract . One patient died from Epstein-Barr virus (EBV)-related posttransplantation lymphoproliferative disorder ( PTLD ) associated with a change from horse-derived to rabbit-derived ATG in the HDIT regimen . An engraftment syndrome characterized by noninfectious fever with or without rash developed in 13 of the first 18 patients and was associated in some cases with transient worsening of neurologic symptoms . There were 2 significant adverse neurologic events that occurred , including a flare of MS during mobilization and an episode of irreversible neurologic deterioration after HDIT associated with fever . With a median follow-up of 24 ( range , 3 - 36 ) months , the Kaplan-Meier estimate of progression ( > /= 1.0 point EDSS ) at 3 years was 27 % . Of 12 patients who had oligoclonal b and s in the cerebrospinal fluid at baseline , 9 had persistence after HDIT . After HDIT , 4 patients developed new enhancing lesions on magnetic resonance imaging of the brain . The estimate of survival at 3 years was 91 % . Important clinical issues in the use of HDIT and stem cell transplantation for MS were identified ; however , modifications of the initial approaches appear to reduce treatment risks . This was a heterogeneous high-risk group , and a phase 3 study is planned to fully assess efficacy Aggressive forms of multiple sclerosis ( MS ) represent a limited group of demyelinating diseases that rapidly progress to severe disability . Currently available therapies are poorly effective against these clinical entities . Recently , it has been demonstrated that intense immunosuppression followed by autologous haematopoietic stem cell transplantation ( AHSCT ) can affect the clinical course of individuals with severe MS and completely abrogate the inflammatory activity detected by MRI . We report the result of the Italian phase 2 GITMO study , a multicentre study in which 21 MS patients , who were rapidly deteriorating and not responding to the usual therapeutic strategies , were treated with this procedure . The clinical effect of the treatment is long lasting , with a striking abrogation of inflammation detected by MRI findings . These results support a role for intense immunosuppression followed by ASCT as treatment in rapidly evolving MS cases unresponsive to conventional therapies There were 21 patients with rapidly progressive multiple sclerosis ( MS ) treated on a phase 1/2 study of intense immune suppressive therapy and autologous hematopoietic stem cell ( HSC ) support with no 1-year mortality . Following transplantation , one patient had a confirmed acute attack of MS . Neurologic progression defined by the exp and ed disability status scale ( EDSS ) did not increase in disability by 1.0 or more steps in any of 9 patients with a pretransplantation EDSS of 6.0 or less . In 8 of 12 patients with high pretransplantation disability scores ( EDSS > 6.0 ) , progressive neurologic disability as defined by at least a 1-point increase in the EDSS has occurred and was manifested as gradual neurologic deterioration . There were 2 patients with a pretransplantation EDSS of 7.0 and 8.0 who died from complications of progressive disease at 13 and 18 months following treatment . Our experience suggests that intense immune suppression using a total body irradiation (TBI)-based regimen and hematopoietic stem cell transplantation ( HSCT ) are not effective for patients with progressive disease and high pretransplantation disability scores . Further studies are necessary to determine the role of intense immune suppressive therapy and HSC support in ambulatory patients with less accumulated disability and more inflammatory disease activity .  Specifically , more patients and longer follow-up would be required in patients with an EDSS of 6.0 or less before drawing conclusions on this subgroup RATIONALE Phase I/II studies of autologous hematopoietic stem cell transplantation ( HSCT ) for multiple sclerosis ( MS ) were initiated , based on results of experimental transplantation in animal models of multiple sclerosis and clinical observations in patients treated concomitantly for malignant disease . PATIENTS Eighty-five patients with progressive MS were treated with autologous HSCT  in 20 centers and reported to the autoimmune disease working party of the European Group for Blood and Marrow Transplantation ( EBMT ) . 52 ( 61 % ) were female , median age was 39 [ 20 - 58 ] years . The median interval from diagnosis to transplant was 7 [ 1 - 26 ] years . Patients suffered from severe disease with a median EDSS score of 6.5 [ 4.5 - 8.5 ] . Active disease prior to transplant was documented in 79 of 82 evaluable cases . RESULTS The stem cell source was bone marrow in 6 and peripheral blood in 79 , and stem cells were mobilized into peripheral blood using either cyclophosphamide combined with growth factors or growth factors alone . Three patients experienced transient neurological complications during the mobilization phase . The high dose regimen included combination chemotherapy , with or without anti-lymphocyte antibodies or , with or without , total body irradiation . The stem cell transplants were purged of lymphocytes in 52 patients . Median follow-up was 16 [ 3 - 59 ] months . There were 7 deaths , 5 due to toxicity and infectious complications , 2 with neurological deterioration . The risk of death of any cause at 3 years was 10 (+/-7)% ( 95 % confidence interval ) . Neurological deterioration during transplant was observed in 22 patients ; this was transient in most but was associated with MS progression in 6 patients . Neurological improvement by > or = 1 point in the EDSS score was seen in 18 ( 21 % ) patients . Confirmed progression-free survival was 74 (+/-12)% at 3 years being 66 (+/-23)% in patients with primary progressive MS but higher in patients with secondary progressive or relapsing-remitting MS , 78 (+/-13)% ; p = 0.59 . The probability of confirmed disease progression was 20 (+/-11)% . MRI data were available in 78 patients before transplant showing disease activity ( gadolinium enhancing , new or enlarging lesions ) in 33 % . Posttransplant MRI showed activity at any time in 5/61 ( 8 % ) evaluable cases . CONCLUSION Autologous HSCT suggest positive early results in the management of progressive MS and is feasible . These multicentre data suggest an association with significant mortality risks especially in some patient groups and are being utilised in the planning of future trials to reduce transplant related mortality AUTOIMMUNE DISEASES ( AD ) have a high prevalence and cause significant morbidity , health care expense , and mortality . The treatment of certain patients suffering from severe AD , refractory to conventional therapies , is unsatisfactory . Theoretical considerations , pre clinical animal models , and recently published clinical experience support the concept that the natural course of AD may be altered by intensive immunoablation and autologous stem cell transplantation ( ASCT ) . Eradication of autoreactive cells by the conditioning regimen and redistribution of an altered cellular and humoral immunological network , or thymic reeducation , are potential mechanisms for response . On this basis , ASCT is a promising experimental therapy for AD resistant to conventional treatments . We report the preliminary results of the Spanish experience in this field BACKGROUND AND OBJECTIVES Autologous stem cell transplantation ( ASCT ) is currently being evaluated as a therapy for patients with multiple sclerosis ( MS ) . We report the results of a phase II trial to evaluate feasibility and toxicity of CD34 + selected ASCT ( CD34+/ASCT ) and treatment results at one year of follow-up . DESIGN AND METHODS Patients with advanced secondary progressive ( SP ) or relapsing-remitting ( RR ) MS and confirmed worsening of the extended disability status scale ( EDSS ) in the previous year despite interferon or other immunotherapies were included .  Peripheral blood stem cells were obtained by leukaphereses after mobilization with cyclophosphamide ( Cy ) and granulocyte colony-stimulating factor ( G-CSF ) . CD34 + selection was performed by means of an Isolex 300 or CliniMACS device . BCNU , Cy and antithymocyte globulin ( ATG ) were administered as conditioning regimen . RESULTS Fifteen patients ( 9 SPMS and 6 RRMS ) with a median EDSS of 6.0 ( 4.5 - 6.5 ) and a median of 3 ( 1 - 7 ) relapses in the previous year were included . Mobilization was unsuccessful in one patient . During mobilization , one patient had a transient neurologic deterioration . The main complication during ASCT were engraftment syndrome , which developed in three patients , CMV reactivation in one , and neurologic deterioration in two patients coinciding with high-fever related to ATG . Hematologic recovery was fast and complete in all cases . At 12 months , the EDSS had improved in three patients , worsened in two and remained stable in nine . Despite withdrawal of all immunosuppressive therapy only two patients had relapses . Magnetic resonance imaging showed disappearance of enhanced T1 lesions but oligoclonal b and s persisted in the cerebrospinal fluid of all evaluated cases . INTERPRETATION AND CONCLUSIONS CD34 
    Output:
    
Results : For secondary progressive MS , immunoablative therapy with autologous bone marrow/peripheral blood stem cell transplantation was associated with higher progression-free survival ( up to 3 years following treatment ) when using intermediate-intensity conditioning regimens compared with high-intensity conditioning regimens .
Conclusions : Patients with secondary progressive MS refractory to conventional medical treatment have longer progression-free survival following autologous stem cell transplantation with intermediate-intensity conditioning regimens than with high-intensity conditioning regimens