What is HSCT
THE AIMS guide
A comprehensive guide to HSCT. All you need to know about the treatment, plus a review by Dr Majid Kazmi
What is HSCT for MS
What is HSCT for MS is a question we are regularly asked. Even now, it’s still something many people haven’t come across, although it’s been around for a lot longer than you might realise. HSCT (also known as BMT, AHSCT or simply ASCT) stands for Haematopoietic Stem Cell Transplant. HSCT should not be confused with ‘Stem Cell Therapy’ or ‘Stem Cell Treatment’. HSCT has been used to treat MS for over 20 years now. Moreover, it was already a well-established treatment, having been performed 2 million times since 1959, when the first ever bone marrow transplant took place. It is currently performed over 50,000 times every year for cancer, and more than 3,000 patients have had HSCT for MS to date.
Is HSCT the same as a Bone Marrow Transplant (BMT)
Stem cell transplants and bone marrow transplants seem to get mixed up – but are they the same thing? Yes, in HSCT for MS the stem cells must come from the bone marrow and in this context a bone marrow transplant is synonymous with HSCT, Haematopoietic Stem Cell Transplant, Autologous Stem Cell Transplant or Autologous Haematopoietic Stem Cell Transplant.
What is the process of a Stem Cell Transplant?
Prospective HSCT patients often ask what is the process of stem cell transplant? HSCT is a procedure that works by ablating the faulty T and B lymphocyte cells that work to damage the immune system in MS and other haematologically rooted autoimmune conditions. This ablation is achieved with chemotherapy; it is important to note that stem cells alone will not achieve the desired result. When the faulty immune system and the T and B lymphocytes have been wiped out with chemotherapy, naïve stem cells are re-infused into the body. These cells have no memory of MS and are harvested from the patient prior to the immune system’s being wiped out with chemotherapy. The stem cells work to help rebuild a new, functional immune system for the patient – one that is no longer attacking itself. The aim of HSCT is to halt progression, but many patients see symptomatic improvements too.
These links will tell you a little more about how HSCT works on the immune system, and how HSCT works at one of the hospitals AIMS supports
What is the difference between Myeloablative and Non-Myeloablative HSCT?
The difference between Myeloablative and Non-Myeloablative HSCT can sometimes confuse people.
All HSCT protocols for the treatment of autoimmune disorders, and MS specifically, ablate the T and B cells in the body that are responsible for the underlying nerve damage / destruction. However, HSCT protocols run a spectrum from completein-vivo lymphocyte ablation (the myeloablative protocols) to partialin-vivo lymphoablation (non-myeloablative protocols also sometime referred to as "Reduced Intensity Conditioning" (RIC) regimens).
There has been no head to head comparison of the two approaches.
What is the difference between an Autologous and an Allogeneic Transplant?
Patients are sometimes confused by the difference between allogeneic and autologous HSCT. Allogeneic simply means that the cells are harvested from a donor; autologous means they come from your own body.
What is Engraftment?
What is engraftment? Engraftment is when the new cells find their way to the bone marrow and can then begin the process of making new, health cells. This process can take between 10 days to a month, and during this time the patient has no immune system and must therefore be extra cautious when it comes to avoiding infection. Further info on the process can be found here at the MS Trust.
How much does HSCT cost?
How much does HSCT cost is one of the first questions we’re asked at AIMS. In the UK, HSCT can be received on the NHS if the patient meets certain criteria. However, different funding rules in England, Scotland, Wales and NI can mean that acceptance success can be variable. Notwithstanding the funding conditions in different areas, patients must also get a referral to a neurologist from the London MDT via their GP/Neurologist (England) or neurologist (rest of the UK). The criteria are detailed on our website and can also be viewed by clicking here.
HSCT is available privately in the UK from around £90,000. Internationally, the cost of HSCT can vary. At the two international hospitals AIMS supports, Clinica Ruiz in Mexico and AA Maximov, Moscow HSCT is currently available (for accepted patients) at around £39,000-£41,000 (at current exchange rates and not including travel expenses).
How long does it take to recover from HSCT?
People are often concerned about the time it takes to recover from HSCT, and recovery time can vary, but the patient is usually well enough to leave the hospital within two or three weeks of the transplant. On discharge from hospital, some patients choose to follow a neutropenic diet for up to six months, and various precautions should be taken in terms of hygiene and avoiding infection – the most important of these being frequent handwashing. AIMS has known people return to work in as little as 2-3 months, but recovery will be different for everyone.
What are the mortality risks of HSCT?
At AIMS, we feel it’s important to discuss the mortality risks involved with HSCT. As with any medical procedure, there is an element of risk, and HSCT is a chemotherapy which does carry its own risks. However, to be accepted for HSCT, the patient will undergo several rigorous medical checks to ensure that they are suitable for the procedure – this is the case at all HSCT hospitals AIMS supports. HSCT does come with a mortality risk, but this risk varies significantly depending on the type of HSCT used (Myelo, which completely ablates the immune system, or Non-Myelo which ablates most of it – Non-Myelo is used in the UK and at the international hospitals AIMS supports), the drug regimen being used and the condition being treated. Underlying health issues may also cause complications, but Dr Richard K Burt recently stated that the risk of Non-Myelo HSCT for MS is around 0.3%