HSCT– Hematopoetic Stem Cell Transplant
I am planning on having an autologous hematopoetic stem cell transplant. So what does this mean and how does it help my multiple sclerosis?
Multiple sclerosis is a disease where the immune cells in your body go haywire and begin to attack the protective covering on your nerves referred to as myelin. When the myelin becomes damaged, the nerve signals don’t work as well. This can cause problems with walking, nerve pain and tingling, swallowing problems, incontinence, vision difficulties, cognitive issues, and many more.
HSCT works by wiping out all those immune cells that went haywire, and then replacing them with new ones (your stem cells). It’s basically a way to reboot your system, so hopefully the new immune cells behave and the multiple sclerosis goes away!
So the process involves 2 steps:
Step 1– Harvesting your stem cells.
This three week process is performed to collect your stem cells. You are given a cytotoxic chemotherapy (cytoxan) the first day, followed by Neupogen. Neupogen allows your bone marrow to produce more stem cells, while the cytoxan helps mobilize them to the peripheral blood stream. Once you have enough stem cells in your bloodstream, you will be connected to an apharesis machine. This allows for separation and collection of your stem cells. The stem cells will be frozen until time of transplant.
Step 2- Chemotherapy and Stem Cell Transplant
After a break, you are admitted to the hospital. You will receive BEAM therapy to wipe out your cells. The BEAM regimen consists of 4 chemotherapeutic drugs: cytarabine, carmustine, etoposide, and melphalan. Then you remain in the hospital until your immune system starts to reconstitute itself.
There have been many studies investigating HSCT for MS. A nice review of all the data thus far is given in this article:
The American Society of Blood and Bone Marrow Transplantation now recommends that hematopoietic stem cell transplant be “standard of care, clinical evidence available” for multiple sclerosis that is refractory to disease modifying agents.