HSCT is SPMS

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As you know I don’t want to comment to much, as its like catnip for the zealots, but it is important that you see what is being published, as I am not a HSCT denialist either. Immunoablation, which is done with BEAM, that replaces the immune system and you would expect it to inhibit inflammation.

Impact of autologous haematopoietic stem cell transplantation on disability and brain atrophy in secondary progressive multiple sclerosis.Mariottini A, Filippini S, Innocenti C, Forci B, Mechi C, Barilaro A, Fani A, Carlucci G, Saccardi R, Massacesi L, Repice AM. Mult Scler. 2020 Feb 3:1352458520902392. doi: 10.1177/1352458520902392. [Epub ahead of print]

BACKGROUND:Autologous haematopoietic stem cell transplantation (aHSCT) is a valuable option in aggressive relapsing-remitting multiple sclerosis (MS), but its efficacy in secondary progressive (SP)-MS is still controversial.

OBJECTIVE: Assessing efficacy of aHSCT in SP-MS by clinical-radiological outcomes.

METHODS:Open-label monocentric retrospective study enrolling consecutive SP-MS patients treated with BEAM-aHSCT (myeoablation) in the period 1999-2016.

RESULTS:In total, 26 SP-MS patients with moderate-severe disability were included. Progression-free survival (PFS) at years 5 and 10 after aHSCT were, respectively, 42% and 30%. Out of 16 patients who worsened, only 6 patients (23% overall) maintained continuous disability accrual (CDA), whereas 10 patients stabilized following one single-step Expanded Disability Status Scale (EDSS) worsening. CDA-free survival was 74% at 5-10 years. No relapses or magnetic resonance imaging (MRI) activity were reported, thus no evidence of disease activity (NEDA)-3 corresponded to PFS. Annualized rate of brain atrophy (AR-BVL) normalized after 1 year in 55% of the cases analysed (12/22).

CONCLUSION: BEAM-aHSCT halted CDA and normalized AR-BVL in most of the treated patients, inducing long-term remission of inflammatory activity at a median follow-up of 99 months (range 27-222). These data suggest that CDA might still be mainly driven by inflammation in a subgroup of SP-MS and could therefore be reversed by treatments. CDA should be analysed independently from any isolated disability worsening.

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