In MS the immune system mistakenly attacks the protective layer around nerves, called myelin. HSCT (haematopoietic stem cell transplantation) is a procedure that aims to reset the faulty immune system to stop this happening. It does this by partly or fully wiping out your immune system and then regrowing it using your stem cells.
Research has shown that HSCT is most effective for people with MS who:
- have frequent relapses and MRI scans showing new or active lesions – these are signs of ‘active inflammation’
- are early on in their disease course
- don’t have significant disability – measured by the EDSS (Expanded Disability Status Scale)
European guidelines are based on these research results. Most clinics use those guidelines to assess who can have HSCT.
You’re most likely to benefit if you have highly active relapsing MS and you’re still having relapses despite taking disease modifying therapies (DMTs). That’s because HSCT targets the immune system causing the inflammation.
HSCT might also be able to slow down MS if you have progressive MS and still have active inflammation (either relapses or lesions on an MRI).
How does HSCT treatment work?
HSCT aims to ‘reset’ the immune system to stop it attacking the central nervous system. It uses chemotherapy to remove the harmful immune cells and then rebuilds the immune system using a type of stem cell found in your bone marrow. These are the haematopoietic stem cells.
How well does HSCT work?
DMTs can be put into three groups based on how well they control MS. HSCT is classed as ‘high’, the best of the three groups. This is based on how much it reduces relapses and slows down the rate at which people’s disability gets worse.
Clinical trials have shown that HSCT is able to reduce relapses – mainly for people with relapsing MS. For some people their symptoms stabilise or get better, or their disability improves. But these improvements don’t always last.
A randomised control trial looked at 110 people with ‘very active’ relapsing MS. Half of them were treated with non-myeloablative HSCT and the other half with other DMTs. Non-myeloablative HSCT is the kind used to treat MS in the UK. The results showed:
- 99% of the people treated with HSCT had no relapses for 1 year. Only 1 person who had HSCT suffered a relapse. There were 39 relapses in people taking drug treatments
- 94% of people treated with HSCT didn’t see their disability get worse for 3 years (compared to 40% of those on drug treatments)
- EDSS scores (which measure disability) improved for the people treated with HSCT. For those on drug treatments, average EDSS scores got worse