From the Guidelines
Multiple sclerosis (MS) cannot be fully reversed with current medical treatments, but autologous haematopoietic stem cell transplantation (AHSCT) has shown promise in reducing disease activity and slowing progression in certain patients, particularly those with relapsing-remitting MS who have failed high-efficacy disease-modifying therapies (DMTs) 1.
Current Treatment Options
Current treatment options for MS focus on managing symptoms, slowing disease progression, and reducing relapse rates. These include:
- Managing acute relapses with corticosteroids like methylprednisolone
- Modifying disease course with medications such as interferon beta, glatiramer acetate, or newer options like ocrelizumab and siponimod
- Treating specific symptoms with targeted therapies
AHSCT as a Treatment Option
AHSCT has been endorsed as a standard of care for the treatment of relapsing-remitting MS that is refractory to conventional DMTs by several organizations, including the European Society for Blood and Marrow Transplantation and the European Committee for Treatment and Research in Multiple Sclerosis (ECTRIMS) 1. The procedure involves the use of high-dose immunosuppressive therapy followed by the infusion of autologous haematopoietic stem cells to "reset" the immune system.
Rehabilitation and Monitoring
Rehabilitation after AHSCT is crucial to optimize physical fitness, independence, and outcomes, and to treat neurological problems and other disabilities 1. Clinical monitoring should include regular assessments of disability outcomes, cognitive function, and patient-reported outcomes (PROs), as well as MRI monitoring to track disease activity.
Limitations and Future Directions
While AHSCT has shown promise in reducing disease activity and slowing progression in certain patients, it is not a cure for MS, and more research is needed to fully understand its benefits and risks, as well as to optimize treatment protocols and patient selection 1. Additionally, the optimal placement of AHSCT in the treatment sequence and its use in other forms of MS, such as progressive MS, require further study.
From the Research
Reversal of Multiple Sclerosis (MS)
There are no studies that suggest multiple sclerosis (MS) can be reversed. However, various treatments are available to manage the disease.
- Disease-modifying therapies (DMTs) can help reduce the frequency and severity of relapses, slow the progression of the disease, and manage symptoms 2, 3, 4.
- Switching therapies may be necessary if a patient cannot tolerate a particular treatment or experiences breakthrough disease activity 5.
- Stem cell therapy, including hematopoietic stem cell transplantation (HSCT) and mesenchymal stem cell therapy (MSCT), is being explored as a potential treatment for MS, with some studies showing promise in treating patients with variable disease severity 6.
Treatment Options
- DMTs, such as oral treatments with dimethyl fumarate or teriflunomide, are often preferred as starting therapies for relapsing-remitting MS (RRMS) 3.
- Second-line therapies, including natalizumab, fingolimod, or alemtuzumab, may be chosen for patients with breakthrough disease on first-line therapy or rapidly evolving severe RRMS 3.
- Corticosteroids can be used to treat relapses, and various symptomatic treatments are available to manage symptoms 4.