Good results for stem cell treatment of MS

Multiple sclerosis (MS) is an autoimmune disease that progressively damages the nervous system. At the present time, no drug cures the disorder, but several drugs have slowed the course of the disease in recent decades.

In addition, stem cell therapy (HSCT) has sparked much hope.

The goal of this treatment is simply to revive the immune system. Doctors extract the stem cells from the patient's body and then use chemotherapy to break down the immune system. Then the stem cells are transplanted again and can become a new, healthier immune system.

The experimental treatment of stem cells has yielded promising results, but few studies have been conducted and there is little reliable knowledge of the short- and long-term effects.

In 2017, one study showed that the disease had stopped for at least five years in half of the patients treated with stem cells. And here are the results of another study.

Here, the researchers compared patients who received a stopping treatment with those who had a stem cell transplant. It turned out that stem cell treatment seemed a lot better.

Got better

In the new study, Richard K. Burt of Northwestern University and colleagues from a number of countries recruited 110 patients with MS, with a very active disease, who could not be treated with a drug for the treatment of brakes. The participants were divided into two groups, one receiving another anti-brakes and the other a stem cell transplant.

After one year, only three patients in the stem cell group had worsened, while 34 new patients undergoing treatment for brakes had experienced exacerbation. On average, the stem cell group was actually better, while the other became less and less good.

The researchers also found a similar difference after five years. In addition, other targets pointed out that stem cell therapy was superior.

The transplanted participants had fewer episodes of deteriorating symptoms, fewer scars after inflammation of the brain and a better quality of life. A greater proportion was also without any signs of disease activity.

Linked to the danger

Burt and his colleagues provide a strong indication that stem cell transplantation can be an effective treatment for some patients with multiple sclerosis, writes Harold Atkins in a commentary published in the JAMA journal. Atkins himself is studying multiple sclerosis, but has not participated in this study.

However, like Burt himself, he recalls that the study has some weaknesses.

One of the problems was that patients in the study did not have access to the most effective anti-blocking drugs, which were not approved in the study or were not yet on the market at its creation. Thus, it may be thought that the difference between graft and medicine was less with the current selection of drugs.

And it's important because stem cell transplantation can be dangerous. Some become very sick during treatment and stem cell treatment of other autoimmune diseases is deadly.

If one takes the risk of such intervention, it is important that the benefits outweigh the disadvantages compared to safer alternatives.

Stem cell therapy should play a role

It is also important to mention that the study participants were a particular group of patients. They all had a very aggressive illness that had not responded to the brake drugs. Findings from this group may not be transferable to patients with less severe illness.

Atkins said that there remained a lot of questions:

How many brake medications should you try before you decide to start a stem cell transplant? Should we offer such treatment also to patients with less serious illness? And when, during the course of the disease, is stem cell treatment the most effective?

Despite everyone, he still believes that stem cell therapy can be an important offer.

The results confirm that stem cell therapy plays a role in centers that treat patients with very active MS, he wrote in the commentary.

reference:

R. K. Burt, Effect of nonmyeloablative hematopoietic stem cell transplantation on disease-modifying treatment on disease progression in patients with relapsing-remitting multiple sclerosis, randomized clinical trial, JAMA, January 2019. Abstract.

H. Atkins, stem cell transplant for multiple sclerosis, JAMA, January 2019.