b'Medicine & ResearchStem Cell Therapy Compares Well Against DMTsPromising research still leaves open questionsBy Dr. Ben ThrowerAutologous hematopoietic stem cell trans- cellsinthebonemarrow,andmayhaveplantation (HSCT) is an aggressive treatment fewer health risks.that may also be one of the most eective MS results from an immune attack on myelinoptions for relapsing-remitting MS. A recently andaxonsinthecentralnervoussystem.published study looked at how the HSCT HSCT, in eect, reboots the immune systemcompares to standard disease-modifying resultinginafreshimmunesystemthattherapies for MS. should not attack myelin. There are severalAs the number of treatment options for MS steps to HSCT:expand, much thought is being given about 1. Stem cell expansion. Medications are givenwhich therapy is best and for which individual. toencouragethebonemarrowtomakeWe still have more treatment options for more stem cells and send them into therelapsing forms of MS than for progressive blood stream.ones. Ocrelizumab (Ocrevus) is the only FDA-approved option for primary progressive MS. 2. Stem cell collection. Autologous stem cellsFor RRMS, research is showing that more are collected from the blood stream. Someeffectivetherapiessuchnatalizumab, HSCT procedures then make more of theseocrelizumab, and alemtuzumab may offer stem cells by cloning them. The stem cellsbetter chances of disease control when are then saved.started as rst-line treatments. Given this shift 3. Conditioning. A regimen of chemotherapyin thinking towards more eective therapies, is given to shut down the existing immunewhere does HSCT t in? system. This can be myeloablative orHSCT can be either allogeneic or autologous. nonmyeloablative.The former means that the stem cells come 4. Transplantation.Thesavedautologousfrom someone other than yourself, typically stem cells are given back via an infusion.a relative or other closely matched donor. 5. Engrafting. The stem cells generate a newAutologous means the stem cells come from immunesystem.Cellrecoverytendstoyou. The advantage of an autologous trans- take about a month.plantation is the lack of potential for rejectionand the lack of need for long term antirejection One of the leading HSCT research groupsmedications. intheU.S.recentlypublishedresultsofaHSCT can be myeloablative or nonmyelo- study in which patients with RRMS treatedablative. This refers to how aggressive the with HSCT were compared to patients treatedaccompanying chemotherapy is and whether with standard MS disease-modifying therapies.all the existing bone marrow is shut down or This was a nonmyeloablative autologous HSCTnot. Nonmyeloablative spares some of the procedure. Most patients on standard DMTsmsfocusmagazine.org 18'