The procedure involves removing stem cells from a patient’s own blood, then using powerful chemotherapy drugs to knock down the existing immune system.
After that, the stored stem cells are infused back into the patient, and the immune system rebuilds itself over time.
It requires a long hospital stay, plus a period of months when patients are severely immunocompromised, Bebo said.
In the current study, three patients died after their transplant, though none occurred after 2007.
“This is important evidence,” said Dr. Alexander Rae-Grant, a neurologist and fellow of the American Academy of Neurology. “But it doesn’t prove [stem cell transplant] is better than the standard treatments we currently have.”
Still, Rae-Grant said, the longer-term data do offer some reassurance on the safety of the procedure for MS patients, and additional evidence that it is “a reasonable approach.”
Like Bebo, he pointed to the bigger-picture issue: When is it best to try a stem cell transplant?
Right now, Rae-Grant said, the general thinking is that the approach may be best for patients with relapsing-remitting MS who are relatively young and have “very active” disease despite medication.
The trick, according to Rae-Grant, is to strike a balance: Doctors would not want to be overly aggressive in using stem cell transplants, but would also want to intervene early enough to forestall disability as much as possible.
Clinical trials, including one in the United States called BEAT-MS, are underway to directly test stem cell transplant against the most effective MS medications.
Ideally, eligible patients would get into a clinical trial, said Dr. Matilde Inglese, one of the researchers on the current study.
Otherwise, they should consult one of the small number of medical centers with extensive experience in using the procedure for MS, said Inglese, head of the Multiple Sclerosis Center at the University of Genoa, in Italy.
Bebo stressed that point. This is not, he said, an undertaking that can be done at self-described “stem cell clinics” that advertise their services for various conditions.
Even when done at a reputable medical center, other issues loom, including cost.