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HSCT: Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients

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  • ActiveMSers
    The full article is now available for free. They "have implemented a standardized protocol for the multidisciplinary decision-making and informed consent process for treatment of RRMS patients failing a second-line DMD."

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  • HSCT: Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients

    Published: 16 June 2020

    Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients

    Antonio Bertolotto, Serena Martire, Luca Mirabile, Marco Capobianco, Marco De Gobbi & Daniela Cilloni
    Neurology and Therapy (2020)


    Autologous hematopoietic stem cell transplantation (AHSCT) has been used in the treatment of highly active multiple sclerosis (MS) for over two decades. It has been demonstrated to be highly efficacious in relapsing–remitting (RR) MS patients failing to respond to disease-modifying drugs (DMDs). AHSCT guarantees higher rates of no evidence of disease activity (NEDA) than those achieved with any other DMDs, but it is also associated with greater short-term risks which have limited its use.

    In the 2019 updated EBMT and ASBMT guidelines, which review the clinical evidence of AHSCT in MS, AHSCT indication for highly active RRMS has changed from “clinical option” to “standard of care”. On this basis, AHSCT must be proposed on equal footing with second-line DMDs to patients with highly active RRMS, instead of being considered as a last resort after failure of all available treatments.

    The decision-making process requires a close collaboration between transplant hematologists and neurologists and a full discussion of risk–benefit of AHSCT and alternative treatments. In this context, we propose a standardized protocol for decision-making and informed consent process.