HSCT-The Hamburg Experience

Stellmann JP, Stürner KH, Ufer F, Havemeister S, Pöttgen J, Ayuk Ayuketang F, Kröger N, Friese MA, Heesen C. Stem cell transplantation for multiple sclerosis : Hamburg experiences and state of international research Nervenarzt. 2015 May 10. [Epub ahead of print]
BACKGROUND: Autologous hematopoietic stem cell transplantation (aHSCT) is still not the standard treatment for highly inflammatory multiple sclerosis (MS). Even though randomized controlled trials are lacking, predictors for treatment response have been established. Since 2007, ten patients have received aHSCT in Hamburg.
OBJECTIVE: To present observational data from patients treated in Hamburg and a review of the literature.
METHODS:Descriptive statistics were used for evaluating the course of the expanded disability status scale (EDSS) as a measure for clinical outcome, magnetic resonance imaging (MRI) and neuropsychology. New gadolinium and T2-MRI uptake lesions per scan were compared.
RESULTS: The Hamburg series can be divided in two groups, one group including four patients with chronic progressive MS with low inflammatory activity (median EDSS = 6.25, 0.5 relapses per year, no gadolinium-enhancing lesions) and the other group including six patients with mild to moderate disability, relapses and inflammatory activity (median EDSS = 4.25, 1 relapse per year, 2 gadolinium-enhancing lesions). The median follow-up was 2.4 years. While the first group did not seem to benefit from aHSCT, an improvement in five out of six patients was observed in the second group. New T2 lesions occurred within the first 6 months but gadolinium-enhancing lesions were not observed (p < 0.05). A systematic literature search identified a higher efficacy of aHSCT in younger, less disabled MS patients with inflammatory activity, similar to the findings from Hamburg.
CONCLUSION: Cohort reports describe aHSCT as a safe and efficient treatment option in highly inflammatory MS. Based on these data aHSCT seems to be a reasonable option in selected patients with highly inflammatory MS but a randomized controlled trial is warranted.
The article is German but the abstract seems to to reflect a view that HSCT is most active in RRMS. HSCT may not be inert in progressive MSers but it is probable that people with active MS lesions & relapses could be a subset of progressive MSers that could benefit, but more is clearly needed to get progressive MS under effective control.