Why AHSCT should be the future of MS treatment

Autologous Hematopoietic Stem Cell Transplant (AHSCT) is being used more frequently to treat relapse-remitting multiple sclerosis (RRMS) patients. As research continues to support the safety and effectiveness, AHSCT is becoming a powerful option when disease modifying therapies (DMTs) don’t work.

MS is a common autoimmune neurodegenerative disease that affects our central nervous system (CNS), and has affected over 2 million people worldwide. It is when the myelin sheath on the nerve cell becomes damaged, interrupting nerve signals. The most common type of MS is RRMS, 85% of MS patients are relapse-remitting which is where there are periods when symptoms flare up then subside. This is caused by our T-cells attacking our central nervous system. Now, DMTs have been widely used long before AHSCT became an option to treat MS with. However, recent studies have shown that DMTs have been having less of an effect on some RRMS patients. Why? These RRMS patient’s immune systems are too aggressive for standard DMTs to suppress it fully. Additionally, DMTs aim is to suppress the immune system response while AHSCT is said to reset the immune system. 

So what is AHSCT? According to a PubMed article, AHSCT is a treatment involving taking the patient’s own stem cells from their bone marrow, and then using high-dose chemotherapy to wipe out the immune system. Then reintroducing the stem cells into the immune system to rebuild it. This balances pro-inflammatory and regulatory immune cells, suppressing the inflammation in the CNS. Results through different studies have shown that it has significantly improved life quality in RRMS patients as it has greatly reduced the relapse rates.

Even though AHSCT has a huge impact on RRMS patients, this treatment has a temporary effect on primary progressive MS (PPMS) patients, the other 15% of MS patients. It differs as RRMS has stages of relapse but PPMS just progressively gets worse. Despite this, the PubMed article also states that AHSCT has remarkably lowered the treatment-related mortality (TRM), where patients die from the treatment instead of the disease itself, from 7.3% to less than 1.3%.

With growing research and improved safety, AHSCT has become a leading treatment for aggressive RRMS, especially in patients who don’t respond to DMTs. While it’s not able to manage all types of MS, its ability to reset the immune system and reduce TRM rates can provide patients with a new sense of hope. As more evaluation of AHSCT continues, it could shift from being a last resort option to the new standard care to treat selected RRMS patients.