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MS Society officially endorses HSCT!

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  • MS Society officially endorses HSCT!

    Special Communication
    October 26, 2020
    Autologous Hematopoietic Stem Cell Transplant in Multiple Sclerosis
    Recommendations of the National Multiple Sclerosis Society


    Aaron E. Miller, MD1; Tanuja Chitnis, MD2; Bruce A. Cohen, MD3; et alKathleen Costello, MS, CRNP, MSCN4; Nancy L. Sicotte, MD5; Rachael Stacom, MS, ANP-BC, MSCN6; and the National Medical Advisory Committee of the National Multiple Sclerosis Society
    Author Affiliations Article Information

    JAMA Neurol. Published online October 26, 2020. doi:10.1001/jamaneurol.2020.4025

    Abstract

    Importance Autologous hematopoietic stem cell transplant (AHSCT) for multiple sclerosis has gained increasing interest in recent years. Despite the availability of many US Food and Drug Administration–approved disease-modifying therapies, some patients do not respond adequately and others may have very early aggressive disease that prompts consideration of alternative, highly effective, long-lasting therapy. The National Medical Advisory Committee of the National Multiple Sclerosis Society has reviewed recent literature on AHSCT for the purpose of making recommendations about its use based on current knowledge, as well as pointing out areas of controversy and issues requiring further research.

    Observations Studies on AHSCT have repeatedly demonstrated high efficacy and a durable outcome in people with relapsing multiple sclerosis. Recent studies have shown considerable improvement in the safety of the procedure, with much lower mortality rates than were reported earlier. Consensus is emerging about the characteristics of the best candidates for the procedure. Questions remain about the ideal protocol, particularly about the best conditioning regimen to be used to kill immune cells. Larger randomized clinical trials are needed to address the question of whether AHSCT has advantages over the most efficacious disease-modifying agents currently available. One such trial (Best Available Therapy Versus Autologous Hematopoietic Stem Cell Transplant for Multiple Sclerosis [BEAT-MS) is currently in progress.

    Conclusions and Relevance The National Multiple Sclerosis Society believes that AHSCT may be a useful treatment option for people with relapsing multiple sclerosis who demonstrate substantial breakthrough disease activity (ie, new inflammatory central nervous system lesions and/or clinical relapses) despite treatment with high-efficacy disease-modifying therapy or have contraindications to high-efficacy disease-modifying therapies. The best candidates are likely people younger than 50 years with shorter durations of disease (<10 years). The procedure should only be performed at centers with substantial experience and expertise. Ideally, recipients of the procedure should be entered into a single database, and further research is needed to establish ideal cell mobilization and immune-conditioning regimens.

    FULL ARTICLE (FREE):

    https://jamanetwork.com/journals/jam...tm_term=102620
    Dave Bexfield
    ActiveMSers

  • #2
    Another article on the Lancet study:

    New Recommendations Open Door a Bit to Stem Cell Transplant for MS

    October 31, 2020
    AJMC Staff

    Relevant Topics
    The procedure might work best in patients who have had multiple sclerosis (MS) for less than 10 years, the report said.

    Patients younger than 50 years of age with a shorter duration of multiple sclerosis might be considered candidates for an autologous hematopoietic stem cell transplant (AHSCT).

    Earlier this week, the National Medical Advisory Committee of the National Multiple Sclerosis Society published recommendations in JAMA Neurology about this issue based on current research.

    However, the committee also said further research is needed and said some issues remain unresolved. The committee also said the procedure should only be performed at centers with substantial experience and expertise.

    The committee concluded that AHSCT may be a useful treatment option for patients with relapsing MS who demonstrate substantial breakthrough disease activity despite treatment with high-efficacy disease-modifying therapy (DMT) or who have contraindications to high-efficacy DMTs.

    They also said that AHSCT might work optimally in people who have had the disease for less than 10 years.

    The recommendations note that previous research studies have concluded that the likelihood of benefit from AHSCT is much smaller for patients with progressive MS without recent disease activity. In addition, patients who are older and have greater disability have a greater risk for serious complications or death associated with the procedure.

    https://www.ajmc.com/view/new-recomm...nsplant-for-ms
    Dave Bexfield
    ActiveMSers

    Comment


    • #3
      Stem cell transplantation has been done on people with multiple sclerosis since the early 2000s, and really picked up steam by 2005. I was transplanted in 2010. Boy, this is taking time! Hopefully FDA approval isn't another decade away. Folks can't wait.
      Dave Bexfield
      ActiveMSers

      Comment

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