A gruelling therapy that is usually a treatment for blood cancers can slow the progression of a common type of multiple sclerosis, a new study suggests.
Stem cell transplants aim to reset the immune system and researchers said they hoped that the treatment could become part of standard care for MS patients in future.
In autologous haematopoietic stem cell transplantation (aHSCT) blood cells are harvested from a patient’s own bone marrow or blood and then reintroduced following chemotherapy. The procedure has shown promise for patients with relapsing remitting MS in clinical trials and the new study, published in the Journal of Neurology, Neurosurgery and Psychiatry, suggests that it also works when given as routine clinical care.
By studying data on 174 patients in a national Swedish register who were treated with aHSCT between 2004 and 2020 they calculated that a patient had 1.7 relapses in the year before aHSCT treatment and would have one relapse every 30th year after treatment. People with relapsing remitting MS have spells where their symptoms get worse but these are followed by a period of recovery. After each relapse, however, their disability can end up worse than before.
The BBC journalist Caroline Wyatt had MS diagnosed in 2015. She wrote about travelling to Mexico to access stem cell treatment in 2017, with initial success, although her condition has since relapsed.
In the new study the research team found no evidence of disease activity in 73 per cent of those treated after five years and in 65 per cent after ten years.
Among the 149 MS patients with some disability to begin with, 54 per cent improved, 37 per cent remained stable and 9 per cent got worse. Although a number of patients required intensive care or had infections, none died as a result of the treatment.
The observational study had no comparative group, which the researchers acknowledged meant that no definitive conclusion was possible, but they said: “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.”
According to the MS Society UK there are more than 130,000 people with the condition in the UK and nearly 7,000 have it newly diagnosed each year. Symptoms include fatigue, muscle spasms and pain, as well as problems with vision, mobility, thinking, talking and swallowing.
Dr Sarah Rawlings, executive director of research and external affairs at the MS Society, said: “[The treatment] on the NHS is subject to strict eligibility criteria and can be difficult to access. We know [aHSCT] doesn’t work for everyone with MS, but it has been an important development in MS treatment and some people see life-changing results.
“This study provides further evidence as to how it can help slow progression of symptoms.”
She said there was still not enough evidence comparing stem cell treatment with the most effective therapies available but a UK trial called StarMS is seeking to do so.
Rawlings said: “We would urge anyone considering aHSCT or interested in taking part in the StarMS trial to discuss this with their neurologist.”
Dr Alena Pance, a senior lecturer in genetics at the University of Hertfordshire, said: “The disability caused by MS is the result of damage or degradation of the myelin that envelops and protects the nerves of the central and peripheral nervous system.
“Though aHSCT can generate only blood cells (of all types) and not cells of the neuronal system, resetting the immune system stops the constant attack on myelin, which then gives a chance to the specialised repair cells called oligodendrocyte precursors to regenerate the damaged myelin.
“However, the potential and extent of repair depends on the severity of the disease, which is why, as the study indicates, the effect on disability is greater the lower the severity of the disease is.”
