Stem cells harvested from an individual’s own bone marrow or blood can slow progression of multiple sclerosis, according to Swedish research revealed today.
Autologous haematopoietic stem cell transplantation (aHSCT), used to treat blood cancers, involves harvesting stem cells followed by chemotherapy and antibody treatment.
Now there is growing evidence that the method is suitable for treating relapsing-remitting MS, the researchers say.
Because aHSCT has yet to be included in most national clinical guidelines, a team of researchers from Uppsala University wanted to assess its safety and effectiveness when used in routine healthcare. Their findings are published in the Journal of Neurology Neurosurgery & Psychiatry.
They identified 231 patients with relapsing-remitting MS, of whom 174 had been treated with aHSCT before 2020. Their average age when treated was 31 and 64% were women.
They analysed data collected from the Swedish MS registry and safety was assessed by scrutinising the patients’ electronic medical records for the 100 days following the procedure.
On average, patients had had their disease for more than three years and had received an average of two lots of disease modifying drugs before aHSCT, although 23 had not had any treatment.
At about three years, on average, after undergoing aHSCT, 20 patients (11%) were given a disease modifying drug and there was no evidence of disease activity in 73% of those treated after five years and in 65% after 10 years.
Of the 149 MS patients with some disability to begin with, 54% (80) improved, 37% (55) remained stable, and 9% (14) got worse.
The annualised relapse rate was 1.7 in the year before aHSCT and 0.035 during the monitoring period, which averaged 5.5 years, which means a patient had, on average, 1.7 relapses in the year before aHSCT treatment, and one relapse every 30th year after aHSCT treatment.
Five patients needed intensive care and 61 developed a bacterial infection within 100 days of treatment, with febrile neutropenia being the most common side effect, affecting 68% of patients.
As this is an observational study, with no comparative group, no firm conclusions can be made, but the researcher write: “Our findings demonstrate that aHSCT for [relapsing-remitting MS] is feasible within regular healthcare and can be performed without compromising safety.
“Our study corroborates the results observed in the only randomised controlled trial conducted to date. We believe that aHSCT could benefit a greater number of MS patients and should be included as a standard of care for highly active MS.”
Silfverberg T, Zjukovskaja C, Ljungman P et al. Haematopoietic stem cell transplantation for treatment of relapsing-remitting multiple sclerosis in Sweden: an observational cohort study. Journal of Neurology Neurosurgery & Psychiatry 26 September 2023; doi 10.1136/jnnp-2023-331864
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