Questionnaire

APPLICATION FOR TREATMENT

(AHSCT)
BEFORE YOU START
ELIGIBILITY CRITERIA
FOR AHSCT
READ THE ARTICLE BELOW
INCLUSION CRITERIA
        • Age 16 – 70.
        • 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.
        • Chrohn'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
                        Any condition that affects normal functions of organs such as heart, kidneys, lung, liver etc.

                        • As this would limit your ability to receive high-dose chemotherapy immunosuppressive therapy with AHSCT.
                        • Any active or long term infection caused by viruses, fungi or bacteria.
                        • Uncontrolled diabetes.
                        • A positive test for HIV, Hepatitis B and Hepatitis C.
                        • Life expectancy is severely limited by another illness.
                        • 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.
                        • Unability to give written informed consent in accordance with research ethics board guidelines.
                        • High disability level in MS patients (EDSS>6.5) and/or stable non-active disease during the last 2 years
                              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.
                              Note: After clicking send button, application may require some time to send details and to create your profile. Please be patient, and do not rush to refresh the page until you'll be redirected to the private policy page or a "smth went wrong" message will showed up, thank you)))