Multiple Sclerosis Treatment Overview: AHSCT

Recently, I’ve had the pleasure of talking to a number of different local multiple sclerosis support groups about multiple sclerosis (MS) and MS research.  These events generally involve me giving a small presentation, followed by (I’m pleased to report) lengthy question and answer sessions led by the interests of the audience.  Having noticed some common themes in questions asked, I thought it worthwhile to address them with our wider online audience as well.

The focus of today’s article is AHSCT and how it may be used as a treatment for MS.

What is AHSCT and will it work for me?

If one topic has dominated the multiple sclerosis research and treatment landscape over the past year, it has been AHSCT.  Let’s start with the basics….what does AHSCT stand for?  Essentially, it’s a lot of big words – Autologous Haemotopoeitic Stem Cell Transplant.

Next question, what do all these words mean??

Autologous refers to the fact that the cells you are receiving are your own.

Haemotopoeitic refers to the type of cells that you are receiving, which are from your bone marrow.

Stem Cell is the type of cell that has the ability to become new cells in the body.

Transplant refers to the fact that your cells are being returned to your body after the treatment.

Hopefully this helps clear up what we are talking about, but why might this be useful for people with multiple sclerosis?

The important ‘treatment’ part actually comes before the transplant and this is essentially chemotherapy, which you have likely heard about before for cancer treatments.  There are a number of different places around the world offering AHSCT for people with multiple sclerosis, however, they can differ in the intensity/strength/dose of chemotherapy that they use.

Multiple sclerosis is classically known as an autoimmune disease – that is, the immune system starts to attack the insulation around nerves called the myelin sheath.  The chemotherapy part of the treatment works by killing all of the existing bone marrow, which deletes all of the cells in the immune system, thus eliminating all of the cells that are causing the damage.  In this way, it is just a much more powerful, complete version of other multiple sclerosis medications that are currently available for relapsing-remitting MS (RRMS).

At this point, the immune system is either very weakened or non-existent.  To fix this, the bone marrow transplant (i.e. the haemotopoeitic stem cell transplant) is performed to ‘reboot’ the immune system.  As these are your own cells that are being put back in, they are theoretically still the same cells that were initially causing the problems.  However, they have been put back in a ‘naive’ state – the best way of explaining this is that they are young cells that haven’t yet been taught or triggered to start attacking the myelin.

This shows that there is a good scientific basis for AHSCT as a treatment, but does it work?  The answer is similar to if I was asked that question about other MS therapies:  for some people yes, for other people no.  Indeed, we now have some data from long-term studies that have shown that people can achieve good remission from multiple sclerosis for many years.  However, there are still cases where other people have not received any benefits from the treatment.

So will it work for you?  Unfortunately, there is no clear-cut answer to that.  While we are starting to get a better idea of the ‘profile’ of the sort of person with multiple sclerosis that is most likely to benefit, this still isn’t a perfect science.  As with all treatment decisions, it is important to get as much information as possible and ask as many questions as you need to.  The decision is then a very personal one, based on your own situation, where both the benefits and the risks must be weighed.

I hope that this has helped clarify some important points about a big topic in MS research.  If you have more questions, don’t hesitate to ask me by commenting under this post on the Facebook page or by e-mail.  If you have any other topics that you would like me to do a similar article on, I’d love to hear from you about that as well.