Is a second transplant an option???

[ActiveMSers]

I get asked this question frequently. If HSCT fails in halting your multiple sclerosis—which studies have shown that as many as 50% fail HSCT within 10 years—is a second transplant an option? The answer is not necessarily straightforward. For cancers, HSCT has been repeated on patients with varying success, but in those cases there really aren't other options. So technically with MS, you could get another transplant. But should you get another?

Generally, MS HSCT specialists I've spoken with, the answer is probably not. Here's why....

1. It's riskier and the odds of getting blood cancers in the future from the additional chemotherapy is significantly higher.
2. If it didn't hold the first time, odds are no better and almost certainly worse that it will hold the second.
3. If your MS is progressing without relapses, that means you are likely in the progressive stage of the disease, which is more resistant to HSCT.
4. You are now older, and you've now had MS longer, both factors in HSCT effectiveness.

There are people with MS who have tried and generally the result has been failure or worse, an acceleration of disability. Even so, HSCT is so effective that even the opportunity of a temporary reprieve from this disease is appealing. Unfortunately, the expense, risk, and chance for long-term success make it just short of a fool's errand. I looked into it a couple years ago, and begrudgingly concluded that at my age, SPMS status, now a wheelchair user, and the fact that only one or two facilities in the world would even consider a case like mine (not for medical reasons, but for profit), it was a no.