For those to whom AHSCT is not a familiar term, bone marrow transplant is often the lay term used for the procedure. The therapy was first put to use for people with particular types of cancer — with mixed effect. The transition from cancer therapy to MS treatment was a rocky one, during which many lives were put at risk and some were lost. Full disclosure: I personally knew two people who died during their participation in AHSCT trials. Their sacrifice helped lead researchers and patient advocates to modify and improve the treatment to the point it can now be recommended to some people living with MS. After years of reviewing research data, a consensus is beginning to coalesce around the criteria clinicians should use in advising patients about the suitability of AHSCT as a viable treatment option. RELATED: Blood Stem Cell Transplants Show Promise for Active Multiple Sclerosis
What AHSCT Involves
I have personally always considered AHSCT as the “nuclear option” for my course of multiple sclerosis. Much of the data I read when considering entering a research study as a recipient of my own stem cells showed it to be an effective but arduous procedure. While some studies tried a shorter and less drastic approach, the best outcomes seemed to result from the most aggressive versions of the therapy. The process involves the destruction of the body’s immune system via chemotherapy agents, a lengthy hospital stay in quarantine, and an extended period of isolation as the body takes three to six months to rebuild defenses from scratch. The goal is to “reset” the immune system to a point where it doesn’t “remember” that it liked to attack our central nervous system. During the rebuilding phase, people who undergo AHSCT are dangerously susceptible to infections, which is why they must be isolated.
Like Any Treatment, AHSCT Has a Cost-Benefit Ratio
As with all choices in this life with MS, every person must weigh the cost-benefit ratio of any potential treatment. The growing evidence suggests that AHSCT, while not for everyone, may be highly effective and even desirable for people who fall within specific parameters. While early trials focused on people with well-advanced MS (due mostly to the high risk factors), the newest data suggest that certain people with relapsing-remitting multiple sclerosis may be best suited for the treatment.
Research Data Leads to Recommendations for Future Use
According to the latest recommendations of the National Multiple Sclerosis Society, published in October 2020 in JAMA Neurology, the best candidates for the treatment:
Are under age 50Have had MS for 10 years or lessHave relapsing MS, defined as “breakthrough” disease (new inflammatory MS lesions in the central nervous system or clinical relapses) despite being treated with a highly effective disease-modifying therapy (or for whom the use of a highly effective disease-modifying therapy is contraindicated)
Research is, of course, continuing. A further study — entitled BEAT-MS, for Best Available Therapy Versus Autologous Hematopoietic Stem Cell Transplant for Multiple Sclerosis — is currently enrolling subjects to look further into safety and efficacy of AHSCT.
Even With Guidelines, It’s Still a Complex Treatment
Outside of the research setting, only transplant centers that are certified by the Foundation for the Accreditation of Cellular Therapies (in the United States), or the European Society for Blood and Marrow Transplantation (in Europe) are recommended to people with MS considering the treatment. AHSCT is a complex treatment with many risks and significant possibility for reward. To my mind, it is still the nuclear option as a weapon against our collective foe. But with this announcement and its guidelines, it appears that command and control has been put in the field. Wishing you and your family the best of health. Cheers, Trevis
