Bone Marrow Transplant for Multiple Sclerosis
Multiple Sclerosis – a neurological condition where the myelin sheath that insulates the axons of nerve cells is destroyed – affects nearly 3 million people in the world, leading to significant disability in young adults.
MS is thought to be an autoimmune inflammatory process involving overactive T-cells and B-cells.
While there are several disease modifying medical treatments available that target this immune response, not all cases respond well to medications and the medications themselves can have risks to the person.
An emergency experimental approach in treating aggressive MS is to treat it “at the source.” Rather than using medications to try to “quiet down” portions of the T-cell and B-cell response, some researchers are trying to “reset” or “reboot” the immune system much like a person would reboot a computer that is having glitches.
Autologous hematopoietic stem cell transplantation – often referred to as a “Bone Marrow Transplant” – has various approaches. Typically, a person is first given hematopoietic Growth Factors to increase the creation of stem cells that are responsible for creating T-cells and B-cells. These stem cells are collected from the person and stored. The person is then given strong chemotherapy and/or irradiation to stop bone marrow activity. The recently harvested stem cells are then reintroduced to the person and slowly begin to produce new T-cells and B-cells afresh. It typically takes 3 to 6 months for the full immune system to return, ideally without the excessive inflammation that had previously caused MS.
The aggressive Bone Marrow Transplant procedure can have increased serious risks, including infection or death.
A number of research trials have been completed and are in process to assess the risks and benefits of this approach. Existing results suggest approximately 50% of people will have no progression or relapse in MS in the 5 years following the Bone Marrow Transplant, even without any medications directed at MS. This takes into account both a lack of new symptoms due to MS and also a lack of new MS lesions on MRI of the brain.
Because of the serious risks involved with the procedure itself, Bone Marrow Transplant is currently only considered when someone has severe MS that does not respond to disease modifying medications.
MS care is rapidly improving with more options available to people. The Neurologist will be able to discuss all available options and partner with the patient for the best outcome possible.