TagHSCT

An ethical quandary

Barts-MS rose-tinted-odometer: ★★ The two case studies below are creating an ethical quandary in my MS practice. Can you help me please? Case 1The first is the 40-year old woman with MS who is NEDA-2 (no evident disease activity) on DMF (Tecfidera) with no documented relapses in the last 4 years and a series of annual MRI scans with no new or enlarging T2 MS lesions. However, there has been a...

Refusenik

Barts-MS rose-tinted-odometer: ★★ She is only 24 years of age; a graduate trainee in a marketing company. She has a promising future ahead of her. She lives in London and has a long term partner; they met at University. She knows he is the one for her and they are planning to get engaged in the next 1 to 2 years. Like most graduate trainees they find London expensive and share a house with four...

Curing MS

Barts-MS rose-tinted-odometer: ★★★★★ I have been asked many times if we can cure someone who has MS. I have tried to explain what an MS cure may look like many times on this blog and have actually published articles defending the definition.  I explained in a previous post that you may be cured of your MS, but still, have worsening or progressive disease. The difference between progressive...

The Star-MS trial: to be HSCTed or not

Barts-MS rose-tinted-odometer: ★★★ There is little doubt in my mind that HSCT is the most effective DMT we have for treating MS. The latter is based on NEDA (no evident disease activity) rates post-HSCT and brain volume loss data after year one. HSCT appears to put the majority of treated patients into long-term remission and normalises end-organ damage as measured by brain volume loss. In...

The second wave hits

In the face of a second lock down Europe is waking up to the realization that COVID19 is now here to say. If something is here to say, the chances are that it would become the norm. For most this will mean wearing face masks, limiting social contact and being careful on a day to day based on background population infection rates. For those with MS and others on regular immunosuppressants, things...

HSCT makes the recommended list

Barts-MS rose-tinted-odometer: ★★★★★ Good news for people with MS living in the US. The National Multiple Sclerosis Society is acknowledging that autologous hematopoietic stem cell transplant (AHSCT) is an effective treatment for MS as is recommending  AHSCT a useful treatment option for pwMS who have substantial breakthrough disease activity despite treatment with high-efficacy DMTs or have...

Beyond the B-cell: cognitive dissonance

I continue to be amazed when I hear senior MS neurologists make the claim they have never prescribed alemtuzumab or referred any of their patients for HSCT and don’t intend to do so either. These same neurologists seem to be happy with natalizumab and ocrelizumab as their #1 high-efficacy go to DMTs. When I challenge them with the exceptional longterm outcomes for pwMS treated early with...

HSCT is shifting the Bell curve

Barts-MS rose-tinted-odometer  ★ ★ ★ The good news is that the use of autologous HSCT to treat autoimmune diseases rose (by 19%) in the European Bone Marrow Transplant registry in 2018. Importantly, this rise was predominantly due to HSCT treatment for multiple sclerosis. This would indicate that at least at the very right of the bell curve there is increasing use of a more aggressive...

Adenovirus infection after HSCT

Adenovirus is pretty common in the general population, responsible for the common cold, sore throat, bronchitis, diarrhea and conjunctivitis. It is harmless in most instances and like the herpes virus, most of us remain latently infected. During periods of immunosupression, however, the adenovirus can reactivate causing untoward trouble. The latter can range anywhere from organ-specific...

HSCT Units can you please show me the data?

Barts-MS rose-tinted-odometer  0/★ I am often asked why given the extraordinary efficacy of HSCT in early RRMS, but not advanced MS, why I don’t refer more of my patients for HSCT early on in the course of their disease. There are several reasons these are the main ones.  Firstly, to be eligible for HSCT under our London guidelines patients have to fail at least two DMTs one of which has to be a...

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