In this study the results of a randomisation non-ablative HSCT stem cell therapy compared to current DMT and it does better. Much better
This is not surprising we know that immune depleteion is effective.
Effect of Nonmyeloablative Hematopoietic Stem Cell Transplantation vs Continued Disease-Modifying Therapy on Disease Progression in Patients With Relapsing-Remitting Multiple Sclerosis A Randomized Clinical Trial Richard K. Burt, MD; Roumen Balabanov, MD; Joachim Burman, MD; Basil Sharrack, MD; John A. Snowden, MD; Maria Carolina Oliveira, MD; Jan Fagius, MD; John Rose, MD; Flavia Nelson, MD; Amilton Antunes Barreira, MD; Kristina Carlson, MD; Xiaoqiang Han, MD; Daniela Moraes, MD; Amy Morgan, APRN; Kathleen Quigley, RN; Kimberly Yaung, RN; Regan Buckley, RN; Carri Alldredge, RN; Allison Clendenan, APRN; Michelle A. Calvario, APRN; Jacquelyn Henry, APRN; Borko Jovanovic, PhD; Irene B. Helenowski, PhD
IMPORTANCE Hematopoietic stem cell transplantation (HSCT) represents a potentially useful approach to slow or prevent progressive disability in relapsing-remitting multiple sclerosis (MS). OBJECTIVE To compare the effect of nonmyeloablative HSCT vs disease-modifying therapy (DMT) on disease progression. DESIGN, SETTING, AND PARTICIPANTS Between September 20, 2005, and July 7, 2016, a total of 110 patients with relapsing-remitting MS, at least 2 relapses while receiving DMT in the prior year, and an Expanded Disability Status Scale (EDSS; score range, 0-10 [10 = worst neurologic disability]) score of 2.0 to 6.0 were randomized at 4 US, European, and South American centers. Final follow-up occurred in January 2018 and database lock in February 2018. INTERVENTIONS Patients were randomized to receive HSCT along with cyclophosphamide (200 mg/kg) and antithymocyte globulin (6 mg/kg) (n = 55) or DMT of higher efficacy or a different class than DMT taken during the previous year (n = 55). MAIN OUTCOMES AND MEASURES The primary end point was disease progression, defined as an EDSS score increase after at least 1 year of 1.0 point or more (minimal clinically important difference, 0.5) on 2 evaluations 6 months apart, with differences in time to progression estimated as hazard ratios. RESULTS Among 110 randomized patients (73 [66%] women; mean age, 36 [SD, 8.6] years), 103 remained in the trial, with 98 evaluated at 1 year and 23 evaluated yearly for 5 years (median follow-up, 2 years; mean, 2.8 years). Disease progression occurred in 3 patients in the HSCT group and 34 patients in the DMT group. Median time to progression could not be calculated in the HSCT group because of too few events; it was 24 months (interquartile range, 18-48 months) in the DMT group (hazard ratio, 0.07; 95% CI, 0.02-0.24; P < .001). During the first year, mean EDSS scores decreased (improved) from 3.38 to 2.36 in the HSCT group and increased (worsened) from 3.31 to 3.98 in the DMT group (between-group mean difference, −1.7; 95% CI, −2.03 to −1.29; P < .001). There were no deaths and no patients who received HSCT developed nonhematopoietic grade 4 toxicities (such as myocardial infarction, sepsis, or other disabling or potential life-threatening events). CONCLUSIONS AND RELEVANCE In this preliminary study of patients with relapsing-remitting MS, nonmyeloablative HSCT, compared with DMT, resulted in prolonged time to disease progression. Further research is needed to replicate these findings and to assess long-term outcomes and safety. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT00273364
They use T and B cell depletion (CY and the anti-thyocyte globulin kills B cells) and then protect people from infection with stem cells. This is compared in relapsing MS to other treatments and the conclusion is that this does better. I have no problem with this ,but what would you expect if you are comparing this with treatment with CRAB drugs. If you want HSCT and end up with a CRAB I wonder.
21 patients received natalizumab and 6 mitoxantrone which I can buy but 14 on dimethyl fumarate, 14 fingolimod, 9 glatiramer acetate, 7 interferon beta-1a and 1 teriflunomide you are biasing your results as these will have known less efficacy. This should have been compared with alemtuzumab.
Anyway I am sure it will create a alot of discussion