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Multiple Sclerosis (MS)

Transplant advances and outcomes

Multiple sclerosis (MS) is a chronic, autoimmune, degenerative disease affecting nearly 1 million adults in the United States. [1] Most patients present with symptoms between 20 and 40 years of age but have varying rates of disability impairment. [2]

There is currently no cure for MS. However, research has shown that autologous HCT is an efficient and safe treatment for active relapsing forms of MS to help prevent relapse, lesion-activity, and worsening disability while limiting unexpected adverse events. [2] In addition, patients with aggressive forms of MS may particularly benefit from transplant accompanied by high-dose immunotherapy. [3, 4] Together, these treatments suppress the autoimmune inflammatory response and promote immune recovery.

The American Society for Transplantation and Cellular Therapy (ASTCT) has recommended autologous transplant be considered for “standard of care, clinical evidence available” treatment of refractory-relapsing MS. [1]

Recommended timing for transplant consultation

  • After MS relapse, with ≥2 relapse episodes in past 3 years, while on disease modifying therapy
  • Refer patient prior to progression of severe disability: patient must be able to walk 100 meters (with unilateral assistance: cane, crutch or brace).

References

  1. National Multiple Sclerosis Society. Landmark Study Estimates Nearly 1 Million in the U.S. Have Multiple Sclerosis. February 15, 2019. Accessed June 9, 2022.  Access
  2. Cohen JA, Baldassari LE, Atkins HL, et al. Autologous Hematopoietic Cell Transplantation for Treatment-Refractory Relapsing Multiple Sclerosis: Position Statement from the American Society for Blood and Marrow Transplantation. Biology of blood and marrow transplantation: journal of the American Society for Blood and Marrow Transplantation. 2019;25(5):845-854. doi:10.1016/j.bbmt.2019.02.014. Access
  3. Muraro PA, Pasquini M, Atkins HL, et al. Long-term Outcomes After Autologous Hematopoietic Stem Cell Transplantation for Multiple Sclerosis. JAMA neurology. 2017;74(4):459-469. doi:10.1001/jamaneurol.2016.5867. Access
  4. Nash RA, Hutton GJ, Racke MK, et al. High-dose immunosuppressive therapy and autologous HCT for relapsing-remitting MS. Neurology. 2017;88(9):842-852. doi:10.1212/WNL.0000000000003660. Access