Hematopoietic stem cell transplant (HSCT) is a process that uses blood-forming stem cells (SC) to treat patients who have cancer, blood disorders and serious problems with their immune systems.
HSCT is currently the only medical hope offered to people suffering from multiple sclerosis (MS) who want to stop the disease – that effectively shuts down the immune system – from progressing further. While there are some relatively new medications that are approved by the FDA, that reduce and slow down the development of MS, so far none of these is able to stop or reverse the condition.
HSCT has been proven to halt MS. Even though it is a grueling process that is tough on the body and soul, and certainly should not be taken lightly, there is considerable evidence that it works. The result is a growing body of patients willing to face the process in their desire to escape from the debilitating chains of MS.
Because it is considered experimental in the USA, and because there are other major technical “roadblocks” in this country that prevent most of the population from getting access to the treatment, most of those opting for HSCT for MS are forced to travel abroad, to countries like Russia and Israel for treatment.
Understanding Multiple Sclerosis
Multiple sclerosis is a chronic disease that involves an immune system attack against the vital central nervous system. It doesn’t follow any set pattern, and its onset is frequently accompanied by impaired vision and stumbling that is caused by a lack of balance. Over time a variety of symptoms and pathological lesions are disseminated anatomically.
The symptoms of MS are varied and its severity, as well as the speed at which it progresses, is unpredictable. Typical mild symptoms include numbness in the toes, fingers and limbs in general, while severe symptoms may include temporary blindness and even paralysis. Even though these are well known, doctors often have difficulty diagnosing the disease until it is deep-seated, and the patient is severely disabled.
Nevertheless, most people with MS are believed to have a reasonably normal life expectancy, based of course on other health factors as well as weight and environmental issues.
How HSCT Works to Halt MS
Blood cells give us immune protection; and the SCs that are responsible for constantly renewing these blood cells (as well as the immune cells) are called hematopoietic stem cells (HSCs). The two hallmarks of these cells are their ability to produce cells that generate different blood cell types, and their ability to renew themselves.
Basic steps in any HSCT process include:
- Stimulation of SC growth
- Collection of SC
- The transplant itself
- Engraftment of the SCs and new immune system
Mobilization of Stem Cells in the Patient’s Body Historically, hematopoietic stem cells were extracted from bone marrow that also contains other cell types. Today the medical profession harvests the stem cells from peripheral blood that is circulating in the body, stimulating (or mobilizing) the stem cells to migrate more quickly, and in greater numbers, into the blood stream. Since only a very small percentage of the cells in the blood will be HSCs, this improves the odds.
Apheresis After about four days of mobilization, apheresis (which is the collection of the stem cells) takes place. The process takes anything from two to four hours during which time it is withdrawn through a catheter and circulated through a machine that separates the different types of cells. Red blood cells are returned to the body and the SCs are frozen and stored in readiness for the transplant.
Chemotherapy This is carried out over a period of days and is done to “shut down” and effectively destroy the existing immune system. Care must be taken that the patient is not exposed to infection.
HSCT The extracted cells are defrosted, and in a process that is very similar to a blood transfusion, returned to the patient’s body. Side effects often include nausea, coughing and chilling, fever and hot flushes, headaches, and stomach cramps.
Engraftment After a couple of weeks, the SCs should be growing well and a new immune system that has no memory of the multiple sclerosis should be developing. One the blood count rises and the while blood cells are able to fight any infection, the patient is discharged.
Recovery This is gradual, and it often takes several years for patients to be able to evaluate the results of the transplant. While the results will vary – some patients having greater success than others – generally the progression and activity of the MS will be halted once the transplanted stem cells have regrown and established themselves.