WHAT IS HAEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) FOR MULTIPLE SCLE- ROSIS?

HSCT or Haematopoietic Stem Cell Transplant is not a new procedure; it has been used to treat cancer since the 1960s, however, it is relatively new treatment that attempts to control the eects of MS.

The objective of using HSCT as treatment for MS is to sort of ‘reset’ the immune system to prevent it from attacking the central nervous system.
It is an intensive treatment pro- cedure that works by destroying the rogue immune system. In other words, the procedure involves the removal of the harmful immune cells that are attacking the brain and the spinal cord, and then using the patient’s own stem cells to effectively re-grow the body’s immune system. The point of the procedure is to ‘reset’ the immune system to prevent any further damage in the brain and the spinal cord. Since the patient’s own stem cells are used for the procedure, it is also known as an Autologous stem cell transplant.

Various clinical trials since 1985, when HSCT was first used to treat MS, have proven that HSCT helps to lessen the chances for the MS condition to relapse. HSCT does this by destabilizing the autoimmune disorder aicted cellular system in the patient’s body and this is precisely why it is now considered to be one of the most promising treat- ment protocol for MS.

WHAT HAPPENS DURING HSCT FOR MS?

Every patient being considered for an HSCT procedure for MS is first reviewed by a team of specialists at the centre. The treatment only begins after the team of specialists give the green signal. The treatment process is as below:

• The process of treatment begins with the infusion of medical drugs into the patient’s body to encourage the stem cells to move out of the bone marrow and into the body’s bloodstream for easy extraction. The process is known as Mobilisation.

  Approximately 10 days later when enough stem cells are present in the blood, the process of extraction begins and the cells are stored for later use.

• The next step involves chemotherapy delivered as an infusion. This part of the process can take a few days to process properly. This chemotherapy could be Myeloablative (completely wipes out the immune system) or Non-Myeloablative (partially wipes out the immune system). The team of doctors then accordingly introduce an additional medicinal drug to temporarily sustain the body or to help control the side eects of chemotherapy.
• The stem cells are then transplanted back into the patient’s blood by a drip. This is done to help regrow the immune system and it usually takes place a couple of days after the chemotherapy procedure, once the drugs have cleared the patient’s system.
• Within 10 and 30 days of the transplant, the stem cells start making new blood and immune cells. The patient might be put on antibiotics and transfusions as the immune system isn’t working yet and the patient might be prone to infections during this period.
• Post the HSCT procedure, the patient needs to spend a month or so in an isolation chamber so that the immune system can recuperate properly.

  HSCT is an aggressive treatment procedure and therefore recovery might take some time – mostly patients take anywhere between three and six months to recover, however, some patients can take more than a year to completely recover.

FOR WHICH TYPE OF (MS) MULTIPLE SCLEROSIS IS HSCT TREATMENT MOST EFFECTIVE?

Various published results have shown that HSCT is most eective for people who have highly inflammatory relapsing-remitting MS (RRMS); can walk; have had MS for at least 10 years; and have not been helped by available disease-modifying therapies. Also, availing HSCT prior to diagnosis can help patients with early progressive MS.

Like any other medical treatment, there are certain side-eects of HSCT for MS – the main risk is associated with traditional chemotherapy that’s used to reduce/deplete the immune system. Reduction/depletion of the immune system makes the patient vulnerable to some bacterial, fungal and/or viral infections. Some of the other side effects include irritation in the mouth and/ or the gastrointestinal tract, and in some cases lung or kidney problems. Further, depending on the regimen used, infertility could also be a risk for some patients. The patient would need to speak to the doctor incharge about these side effects.

MS patients who have a higher degree of disability before the transplant procedure are at risk of losing further mobility as chemotherapy could lead to muscle weakness. Chemotherapy might also add to cognitive problems. While most of the side-effects of HSCT for MS are because of chemotherapy, this treatment procedure has given a new lease of life to many patients who are struggling to live with disabilities related to MS. The best part is that these side-effects wear o with time.

Most patients take about three to six months to completely recover from HSCT, however, some patients take some more time – more than 10 to 12 months to fully recover.

MULTIPLE SCLEROSIS TREATMENT AT FORTIS MEMORIAL RESEARCH INSTITUTE (FMRI)