Although no large clinical trials have yet been conducted, several smaller clinical trials and observational data from several hundred MS patients indicate that aHSCT is more effective than all approved substances. However, due to the risks of the treatment, this procedure is only used in MS in individual cases and after extensive preliminary clarification.
Requirements for treatment
The most important criteria are:
- Aggressive/highly active relapsing-remitting MS with non-response to at least one highly effective approved therapy
- Age not significantly over 50 years
- Evidence of disease activity (relapses, increase in disability, new MRI lesions) in the last 2 years, especially in the last year
- Duration of illness not significantly longer than 10 years
- No medical contraindications
- Disability level of EDSS 6.5 or less. If wheelchair dependency has only recently occurred, treatment can be discussed.
- aHSCT can also be considered for progressive forms of the disease
Procedure
aHSCT is a one-off treatment lasting approx. 4 weeks and involves the stimulation and removal of the patient’s own blood stem cells, chemotherapy to destroy the body’s own immune cells and the reintroduction of the patient’s own blood stem cells to rebuild the immune system.
Known side effects of chemotherapy include nausea, mucous membrane damage and temporary hair loss. During the immune system’s build-up phase, the body is particularly susceptible to infections. Long-term side effects can include the occurrence of cancer (2%) and other autoimmune diseases (5%). Mortality during treatment is less than 1% (no deaths after 2007).
Availability
aHSCT for MS patients was approved as part of a registry study at the USZ and is covered by health insurance (FOPH decision 2018). This procedure is carried out in close cooperation with the Department of Hematology, where the treatment is carried out