Posted on Feb 23, 2017, 6 a.m.
Autologous hematopoietic stem cell transplantation halted progression of Multiple Sclerosis for 5 years in 46% of patients.
Recent research indicates that the transplant of autologous hematopoietic stem cells (AHSCT) is an excellent treatment for multiple sclerosis. It has been determined that the procedure stops disease progression for half a decade in nearly 50 percent of multiple sclerosis patients.
About the Study
The study was spearheaded by Dr. Paolo Muraro from the Imperial College London's Department of Medicine. Dr. Muraro and his colleagues revealed their findings through JAMA Neurology. These results were released on the heels of a separate study that found the success of a similar treatment in patients suffering from relapsing-remitting multiple sclerosis (RRMS). Dr. Muraro and his research team are quick to point out that additional trials are necessary to gauge the efficacy and safety of AHSCT. It is important to note that some patients perished within the first 100 days of treatment.
AHSCT involves the harvesting of a patient's own stem cells. The patient is subjected to a powerful dose of chemotherapy to destroy any diseased cells. The next step is the return of harvested stem cells to the patient's blood. The goal is to restart the production of normal blood cells.
In layman's terms, AHSCT is best understood as a “resetting” of the body's immune system. Though it was already known that this style of treatment resets the immune system and poses certain risks, the length of its benefits was not fully understood. We now have a better picture of these benefits.
The research team studied data from over two dozen treatment centers in 13 countries. They pinpointed 281 patients who suffered from multiple sclerosis and underwent AHSCT from 1995 to 2006. Exactly 78 percent of these patients had a progressive form of multiple sclerosis. The team made use of the Expanded Disability Status Scale (EDSS) to analyze patients' survival after five years of treatment as well as improvements in their multiple sclerosis symptoms. A whopping 46 percent of these patients enjoyed zero disease progression in the five years following treatment. Those with RRMS, characterized by flare-ups (inflammatory attacks) and periods of remission enjoyed the optimal outcomes.
An amazing 73 percent of these patients did not endure worsening of symptoms in the 5 years following AHSCT. Some patients also experienced minor improvements in their multiple sclerosis symptoms following AHSCT. Those with progressive multiple sclerosis enjoyed a rise in EDSS score by 0.14 in the year after treatment. Those with RRMS experienced an EDSS score increase of 0.76. Those of a younger age, minimal immunotherapies before AHSCT and a comparably lower EDSS score also displayed improved outcomes with AHSCT.
The findings described above clearly show promise for the AHSCT use in individuals who suffer from multiple sclerosis. The research team would like to make it perfectly clear that some patients died in the 100 days following AHSCT. Exactly eight patients perished in this time period. It is assumed that the deaths were related to treatment. AHSCT makes use of aggressive chemotherapy that significantly weakens the immune system and spikes one's risk for infection. Since multiple sclerosis is not a disease that is immediately life-threatening, the risk of death posed by AHSCT must be weighed by all multiple sclerosis patients.
Dr. Muraro is adamant that a follow-up study must be performed that includes a group of multiple sclerosis patients who have not received AHSCT. It is clear that additional studies are required to accurately gauge the efficacy and safety of AHSCT. Ideally, a massive randomized controlled trial of AHSCT will be performed in the coming months.
Paolo A. Muraro, MD et al. Long-term Outcomes After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis. JAMA Neurol., February 2017 DOI: 10.1001/jamaneurol.2016.5867