MYELOABLATIVE VERSUS NON-MYELOABLATIVE HSCT

MYELOABLATIVE VERSUS  NON-MYELOABLATIVE HSCT

Many people considering treatment will find it confusing that there are in fact two different types of HSCT available. Learning what differentiates myleoablative from  non-myleoablative HSCT is important in deciding where to be treated and which type is best suited for your specific needs .  On the whole most facilities offering this treatment will opt for one or the other. In more simple terms when considering MYLEOABLATIVE VERSUS NON-MYELOABLATIVE it is important to understand that both forms are  equal in respect of the fact that they both ablate (destroy) the lymphocytes in the body that are self intolerant, and are ultimately responsible for the underlying nerve damage/ destruction. These lymphocytes are the white blood cells that would normally be attentive to destroying bacteria and other harmful substances that make it into our systems, that by becoming rogue are intent on attacking the myelin sheath that surrounds our nerves. Either type of HSCT is designed to get rid of these errant blood cells and replace them with ‘Naive’ ones that are behaving correctly!

MYLEOABLATIVE HSCT

Myeloablative HSCT is the more stringent type of treatment. This is designed to almost completely wipe out  both the body’s (autoreactive) lymphocytes that are the cause of MS, as well as the bone marrow. This type of HSCT most commonly incorporates a BEAM (Carmustine, Cytarabine, Etoposide, Melphalan) chemotherapy protocol which is administered over a period of six days often with the addition of ATG for a couple of days as supplementary rather than essential  lymphoablation. This type of HSCT is considered to be the most reliable, as it destroys the lympocytes more completely and ultimately removes the chance of any of the ‘baddies” surviving!

NON-MYLEOABLATIVE HSCT

The  Non-myleoablative protocol, varies according to the doctor performing it but on the whole it is a less harsh procedure where the  lymphocyte population is not entirely eliminated but instead “diminished” to a threshold level below which autoimmune-mediated damage occurs. The bone marrow is not completely wiped out,  which makes the treatment less dangerous and allows the patient to recover faster.  This  “gentler” chemotherapy coupled with a  lower mortality rate has the trade off that, compared with the myeloablative protocol, there remains a proportion of patients  (20-25%) that fail to succeed in destroying all of the  lymphocytes needed to halt the disease. This can be dealt with post-transplantation  by using “top-ups” of cyclophosphamide infusions (more chemo) retreatments –  to coax  a treated MS patient that has not responded favourably  back into remission. 

It is the general consensus of opinion that if you have a progressive form of MS (PPMS or SPMS) Myleoablative HSCT is the most effective treatment. The general trend however with treatment is a movement towards non-myleoablative as a more favoured treatment around the world. There are currently no places that offer Myleoablative HSCT that will actually treat progressive cases of MS but as more results become available it is exciting to see marvelously successful results using Non-myleoablative HSCT for PPMS and other progressive cases.  The protocol is being continuously tweaked, and the attractive prospect of a less harsh experience coupled with faster treatment and faster recovery times continue to  popularize this option.

7 comments

  1. I have been researching HSCT for my PPMS. I’m 45 yrs, had it since 1995. Done Rebif, Copaxone, then Mitozantrone. it was good for about 10 yrs, now it has turned PPMS within the year.
    I’m ready for this. Let’s DO THIS!

    1. Hi Robyn it must be SPMS as PPMS is diagnosed at the outset. If it was originally RRMS then it would have progressed to SPMS. I hope you have applied to a facility to get treatment. They are listed on the facilities list. Good luck! :-)

  2. diagnosed in 1985 as RLRM MS. am now on tecidera since first made available. hoping to repair loss and stop new activity, my May 2014 mri showed I had no new lesions since prior year, Will stem cel therapy for MS repair existing loss and stop further activity? what are my next steps recommended. I have been treated by dr.dina jacobs at HUP. She tells me she has patients
    who have done stem cel but HUP does not offer this therapy.

    1. Hi Debra, It is hard to say whether HSCT would help you when you have had MS for an extended period of time. It works best for those who were diagnosed within 5 years…..10 is an upper estimation, although people who have had it for 15 years have experienced stopping progression. The longer you have had it the less likely you are to benefit from regaining lost motor skills. However if your intention is to stop progression alone. Good luck!

  3. Hello i still have no diagnostic of ms but i have some symptoms should i wait until get clinical diagnostic?
    To get hsct

    Thanks Luis

    1. Hi Luis, all facilities require a positive diagnosis of HSCT along with an MRI report to confirm, so yes you would have to have this before you can apply anywhere. Good luck.

  4. Hello, I was initially diagnosed with RRMS 12-12-2002 and within the last 2 years diagnosed with SPMS. Does HSCT treatment have history of stopping MS since I have had thiyears, diagnosed with SPMS. Does HSCT treatment have history of working after having MS for 14 years ?

    Thank you
    Dianna

Leave a Reply

Your email address will not be published. Required fields are marked *