CAN AUTOLOGOUS HEMATOPOIETIC STEM INDUCE COMPLETE REMISSION IN A PATIENT WITH MULTIPLE SCLEROSIS?
Multiple sclerosis is one of the most common autoimmune diseases that take place within the nervous system. In the last ten years, significant therapeutic developments have taken place, with more than a dozen drugs approved for the treatment of relapsing‐remitting MS (RRMS). These disease‐modifying drugs (DMDs) are repeatedly administered, and their cost is increasing steadily with time. These DMDs help in reducing the development of disability in the short term and the number of relapses taking place. A recent data analysis from multiple studies shows that the onset of the secondary progressive phase can be delayed. Still, a majority of patients have an ongoing disease activity despite the introduction of new treatments with newer DMDs.
An alternative method for continuous immunosuppression is induction therapy with ablation of the immune system, which could lead to a life-long remission of disease if carried out successfully. Immunoablation can be achieved through chemotherapy with the support of stem cells, also called hematopoietic stem cell transplantation (HSCT). Since the 50s, HSCT is being used for hematological malignancies and offers significant benefits of being a one‐time procedure.
Previously, it has been reported that treatment with HSCT for RRMS leads to improvement in disability and sustained disease remission for up to 5 years. It is still uncertain whether the recent results can be generalized for ten years and beyond. However, there were factors to check if the autologous hematopoietic stem induces complete remission in patients with multiple sclerosis. These factors include:
- No EDSS progression
- No alternative DMD treatment
- No demonstration of ongoing atrophy
- No MRI events
- No clinical relapses taking place
Multiple sclerosis was considered resolved if “sustained complete remission of MS” was present and intrathecal IgG production was absent and no evidence of axonal damage was present. “sustained complete remission of MS” was present and intrathecal IgG production was absent, and no evidence of axonal damage was present.
Even though a definite proof of cure will require life‐long follow‐up and therefore it is proposed that the term “resolved” should be used to denote MS in individuals who have exhibited no signs of active disease in the absence of treatment for at least five years and normalization of intrathecal IgG production and biomarkers of axonal damage.
Studies found that 95% of MS patients and were very stable underwent HSCT. The patients were persistent after standard interferon treatment, and for the most part, even with strong immunomodulation such as mitoxantrone or natalizumab. Nevertheless, it is still possible that some individuals will experience reoccurring diseases.
All in all, Autologous HSCT for MS has been in use for more than 20 years, and already 15 years ago, it was suggested that MS might be a curable disease with this treatment. There is no denying that this treatment, in most cases, leads to long-term stability in patients to the degree that hasn’t been evident in any regular DMD.
References
Tolf, A., Fagius, J., Carlson, K., Åkerfeldt, T., Granberg, T., Larsson, E.M. and Burman, J., 2019. Sustained remission in multiple sclerosis after hematopoietic stem cell transplantation. Acta Neurologica Scandinavica, 140(5), pp.320-327.
Bose, G., Thebault, S.D., Atkins, H.L. and Freedman, M.S., 2020. Does resetting the immune system fix multiple sclerosis?. Canadian Journal of Neurological Sciences, 47(1), pp.1-10.