HSCT on the Increase

How common is HSCT being performed as a treatment for MS and which countries are using it most? 

You may be surprised by the results. 

Snowden JA, Badoglio M, Labopin M, Giebel S, McGrath E, Marjanovic Z, Burman J, Moore J, Rovira M, Wulffraat NM, Kazmi M, Greco R, Snarski E, Kozak T, Kirgizov K, Alexander T, Bader P, Saccardi R, Farge D. Evolution, trends, outcomes, and economics of hematopoietic stem cell transplantation in severe autoimmune diseases.Blood Adv. 2017 Dec 20;1(27):2742-2755

Between January 1994 and December 2015, there were 2097 transplant procedures in 2056 patients (62% female, 8% pediatric <18 years) registered by 247 participating centers in 40 countries.

The main indications based on patients treated were MS (n = 839), connective tissue disorders (n = 596), inflammatory arthritis (IA, n = 178), vasculitis (n = 46), inflammatory bowel disease (In = 191), haematological immune cytopenia (n = 97).

So in 1995 people were largely progressive, but with the realization that it is most active in Relapsing MS this demographic is changing.

Transplant rates differed substantially among participating European countries. The predominant countries of activity were Italy, Germany, Sweden, the United Kingdom, The Netherlands, Spain, France, and Australia.

With respect to stem cell source, there was a significant trend to increasing use of peripheral blood stem cell (1994-1999, 86.3%; 2000-2004, 92.9%, 2005-2010, 98.2%; and 2011-2015, 99.6%; P < 10−3)

Should there be “Centers of Excellence” where there is both HSCT and specialist expertise working closely in the same hospital? The concept of an experienced team might have benefits not only in terms of transplant skills, but also familiarity with the clinical idiosyncrasies within this patient group