Autologous haematopoietic stem cell transplantation for aggressive multiple sclerosis: the Swedish experience

Abstract

HSCT is a very effective treatment of inflammatory active MS and can be performed with a high degree of safety at experienced centres.

Autologous hematopoietic cell transplantation in multiple sclerosis

“…A large North American cohort study of 145 patients (123 RRMS and 28 SPMS), who failed standard disease-modifying therapies including natalizumab, found the 4-year relapse-free survival rate with AHCT to be 80% and NEDA rate to be 68% [30]. A Swedish study of 48 patients (34 RRMS) who had aggressive disease and had failed conventional treatment, including natalizumab, found the relapse-free survival rate to be 87% and a NEDA rate of 68% also [29]. The high NEDA rates seen in patients treated with AHCT is even more impressive when we consider that such patients generally have more active disease than those patients treated in trials for the other types of DMTs [37].…”

“…Limited data about fertility post-AHCT are available. A cohort study of 48 patients (26 females) with MS reported a total of 8 pregnancies after treatment [29]. A total of five healthy infants were born whereas two pregnancies ended in miscarriage and one was ectopic.…”

“…Compared with other DMTs, the risks of early mortality and morbidity from AHCT is relatively high, although this appears to have improved significantly over the past 10 years, due to the use of safer conditioning regimens, better patient selection and increasing experience [30,29] Although AHCT as a one-off treatment is likely to be more cost-effective than modern DMTs used, this will be need to be addressed prospectively in future studies [58].…”

“…Evidence of gadolinium enhancement on MRI prior to transplant is associated with a more favorable outcome [15,29]. Although AHCT is not normally offered to patients with significant long-term fixed disabilities, EDSS score prior to AHCT treatment was reported not to be a good predictor of outcome [50].…”

“…Herpes zoster is probably the commonest late infection post-AHCT in MS [29], and patients are often advised to stay on prophylactic acyclovir for at least 1 year post-transplant.…”