HSCT - So What Was it?

HSCT - Haematopoietic stem cell transplantation.

The MS Society state the following:

Haematopoietic stem cell transplantation (HSCT) is an intense chemotherapy treatment for MS. It aims to stop the damage MS causes by wiping out and then regrowing your immune system, using your stem cells.

Who's it for?

Results have shown that HSCT is most effective for people:

• with signs of active inflammation, as seen by frequent relapses alongside new or active lesions on an MRI scan

• who are early on in their disease course

• without significant disability (EDSS score of less than 6.5).

These results form the basis of European Guidelines that most clinics use to assess who is eligible for HSCT. 

> View the guidelines on the NCBI website

It will mainly include people with highly active relapsing MS who are still having relapses despite taking disease modifying therapies (DMTs). 

If someone has progressive MS and still has active inflammation (either relapses or lesions on an MRI), HSCT may be able to stop or slow this. 

But HSCT can’t regrow nerves or repair damaged myelin, so it can’t help those with advanced progressive MS who are no longer having relapses and don’t shown signs of inflammation on an MRI. 

Researchers are working hard to find effective treatments for people with progressive MS.

How does HSCT work? 

HSCT aims to 'reset' the immune system to stop it attacking the central nervous system. It uses chemotherapy to remove the harmful immune cells and then rebuilds the immune system using a type of stem cell found in your bone marrow, called haematopoietic stem cells. 

The stem cells used in the treatment can produce all the different cells in your blood, including immune cells. But, they can't regenerate damaged nerves or other parts of the brain and spinal cord.

There is still a danger of the sources see you might use to find out about HSCT. I will write much more on this later, but aHSCT is not something that everyone supports for a whole bunch of different reasons.

Sometimes you see the letter 'a' in front of HSCT. This stands for autologous which means that the stem cells that they put back into your body are your own and not someone else's. Personally, I would just call the treatment HSCT from now on.

Here is my own breakdown of exactly what the treatment is. A decent centre will give you a number of days of pretests to make sure that you are not too much of a risk factor to do the treatment in general. Passing these, you will be given steroids and other chemicals to ready your body for your stem cells to be stimulated. Chemicals will be introduced your body to stimulate your bone marrow to produce extra stem cells. You will need to have quite a lot of stem cells harvested to then be re-infused into your body once it is ready. After the stimulation and extraction of these stem cells (most often they will be frozen during the next phase), you will be given a number of days of chemotherapy (in my case, four). This chemotherapy is designed to completely kill off your immune system - the mechanism of the body that is attacking itself. Once your immune system is killed off, your stem cells are then reintroduced into your body. This can be known as your stem cell birthday.

In essence, this is like ctrl, alt + deleting your system so that it can reboot and start again. Your old immune system is destroyed before being rebooted with your new stem cells. If this is successful, then your old immune system, the part responsible for attacking itself, will have been destroyed and you will have a new immune system starting from the stem cells that have been reintroduced into your body.

The whole process appears to be much more fundamental and seems to attack the core problem more than merely providing disease-modifying treatments or disease-modifying drugs.

Courtesy of https://multiplesclerosisnewstoday.com/wp-content/uploads/2016/08/blog_images-31_720.png

As your brain tries to send messages from your neurons and axons down your nervous system to your muscles and elsewhere around your body, your white blood cells and other such mechanisms are attacking the pathways by which your messages are being sent. This means that your messages are struggling to get through, and this can result in physical or mental difficulties in the patient. The idea is to stop the body attacking itself, to stop the body attacking the central nervous system and those pathways that will ensure successful message reception.