Best watch what I say here as Prof Freedman will come to give me a kicking if I get out of line. The MS Society has been asking does treating early and effectively have better outcome than softly softly escalation approach. This study says yes and I would say “duh”. It is the most aggressive immune modulation treatment, of course it is going to work well. However, the doubting miinies will say it is not controlled trial. This will eventually come The UK authors have been waiting to start such a trials for the past few years and once COVID-19 is under some form of control it will crank up to compare HSCT verses alemtuzumab/ocrelizumab. Which will will I suspect the answer is “Duh” isn’t it obvious. Maybe Prof Freedman will tell us if the people are cured.
Das J, Snowden JA, Burman J, Freedman MS, Atkins H, Bowman M, Burt RK, Saccardi R, Innocenti C, Mistry S, Laud PJ, Jessop H, Sharrack B. Autologous haematopoietic stem cell transplantation as a first-line disease-modifying therapy in patients with ‘aggressive’ multiple sclerosis. Mult Scler. 2021 Feb 10:1352458520985238.
Background: Autologous haematopoietic stem cell transplantation (AHSCT) is an effective treatment for patients with multiple sclerosis (MS) who have highly active disease, despite the use of standard disease-modifying therapies (DMTs). However, the optimal time for offering AHSCT to patients with ‘aggressive’ MS is yet to be established.
Objectives: The objective was to explore the safety and efficacy of AHSCT as a first-line DMT in patients with ‘aggressive’ MS.
Methods: All patients with ‘aggressive’ MS who received AHSCT as a first-line DMT in five European and North American centres were retrospectively evaluated.
Results: Twenty patients were identified. The median interval between diagnosis and AHSCT was 5 (1-20) months. All had multiple poor prognostic markers with a median pre-transplant Expanded Disability Status Scale (EDSS) score of 5.0 (1.5-9.5). After a median follow-up of 30 (12-118) months, the median EDSS score improved to 2.0 (0-6.5, p < 0.0001). No patient had further relapses. Three had residual magnetic resonance imaging (MRI) disease activities in the first 6 months post-transplant, but no further new or enhancing lesions were observed in subsequent scans.
Conclusion: AHSCT is safe and effective as a first-line DMT in inducing rapid and sustained remission in patients with ‘aggressive’ MS