Autologous hematopoietic stem cell transplantation can delay multiple sclerosis progression for five years in 46 per cent of patients
Multiple sclerosis is a debilitating, progressive condition that affects approximately 2.3 million people worldwide. It involves a gradual destruction of nerves by malfunctioning immune cells and leads to many health complications. Medication can slow progression in a limited way, but has failed to produce good therapeutic results thus far.
A new hope
A new study led by a team from Imperial College London has tested a procedure called autologous hematopoietic stem cell transplantation (AHSCT) on MS patients to test whether this might halt or reverse some symptoms. This involves first coaxing stem cells to enter the blood from the bone marrow, and collecting these outside of the body. The bone marrow is then exposed to aggressive, and risky, chemotherapy to wipe out any remaining cells. The patient then undergoes a transplant of their own stem cells previously taken out, which appears to act like a reset button for the immune system.
The strategy is not without danger, as 8 patients sadly died out of 281 people who received the therapy. Obliterating the immune system in such a manner renders patients highly vulnerable to infection for a short period.
"We previously knew this treatment reboots or resets the immune system - and that it carried risks - but we didn't know how long the benefits lasted. In this study, which is the largest long-term follow-up study of this procedure, we've shown we can 'freeze' a patient's disease - and stop it from becoming worse, for up to five years. "
Freezing disease progression
The are two main types of MS - progressive and relapsing. In relapsing patients there is frequently a period of relapse after symptoms, which then repeats itself. Progressive versions are generally more serious. 73% of those treated with relapsing MS showed no worsening of symptoms even 5 years after treatment. Out of those with progressive MS, 1 in 3 showed no progression in the 5 year period. A small number of patients even saw improvements, but this was mostly confined to relapsing MS patients.
"These findings are very promising - but crucially we didn't have a placebo group in this study, of patients who didn't receive the treatment. We urgently need more effective treatments for this devastating condition, and so a large randomised controlled trial of this treatment should be the next step. This study is one of the largest to date looking at AHSCT as a treatment for MS and the findings offer some encouraging insights. It shows that AHSCT can slow or stop progression for many years, and the treatment is most effective in people with MS who have 'active inflammation' in their brain and spinal cord"
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