Statement on HSCT for MS: Professor Eva Havrdova

“Immunoablation with rescue autologous hematopoetic stem cell transplantation (HSCT) has been trialled as a treatment for MS since the late 90’s. In the Czech Republic, we have been using HSCT since 1998, before escalation therapies became available. Initially, it was used only in patients with severe MS, and despite their high disease severity, we have occasionally achieved stabilisation of the disease sustained for several years. Nowadays, after data from hundreds of patients treated with HSCT have been evaluated, it has become clear that stabilisation can only be expected within the initial 5 years from diagnosis, and in patients with relapsing disease and without substantial disability. However, at this day and age, such patients can be offered a number of other escalation strategies. In particular, alemtuzumab, a monoclonal antibody against lymphocytes (white blood cells), mimics the effect of immunoablation, and represents a much safer alternative to HSCT, with an additional effect on mitigating brain atrophy. More than two thirds of MS patients are women; therefore alemtuzumab’s permissive pregnancy safety profile represents another advantage over HSCT (in which pregnancy is risky due to the use of cytostatics). This makes alemtuzumab a preferred option; HSCT should be reserved for patients in whom all other highly effective therapies have failed, in particular because its long-term outcomes did not fulfil our original expectations.”

Dr Eva Havrdova, Professor of Neurology, Charles University in Prague, Czech Republic