Tanuja Chitnis, MD, senior neurologist at Brigham and Women’s Hospital and professor of neurology at Harvard Medical School and coauthor of the new National MS Guidelines, spoke with Healio about autologous hematopoietic stem cell transplant as treatment for MS.
She discussed patient groups that would most benefit from the treatments, risks and benefits and take-away messages from the new guidelines.
Which patient groups are best treated with autologous hematopoietic stem cell transplant?
[Those best treated are] relapsing, remitting patients who are under the age of 45 and who have less than 10 years of disease duration.
What are the risks and benefits of an autologous hematopoietic stem cell transplant?
Stem cell transplant is a highly effective way of reducing inflammation, including new relapses and new MRI lesions and it’s quite effective, especially for younger relapsing patients. It is a very involved procedure, which takes anywhere from around 2 weeks for the procedure. In addition, a great deal of follow-up as well as pre-screening [is required]. The concerns are, after the transplant, there is a high risk for infection and so post-transplant we have to be very careful about infections and then potentially for the next 1 to 2 years, there is a significant infection risk.
Is there more research that is needed? In what areas?
One outstanding question is: ‘what is the best combination of treatments or regimens?’ – and there’s several different regimens that have been used; … The question about who is the best candidate still needs more information and the main issue is optimizing safety.
How pervasive is the knowledge and expertise of clinicians who can perform autologous hematopoietic stem cell transplant? What does access to this type of treatment look like, whether distance, monetary or otherwise?
Clinicians need to be very familiar with this procedure to administer it. They may potentially be working with an oncology unit because oncologists use this procedure more frequently than neurologists typically do. Sometimes people are cross trained in neurology and oncology or work with an oncology unit, or have developed their own expertise as a neurologist. Conduct of autologous hematopoietic stem cell transplant really requires that deep understanding of the procedure, as well as the side effects.
Currently, there are very few centers within the U.S. who are performing stem cell transplant, and I won’t guess how many but it’s less than five. It’s a very specialized type of treatment [and] it may or may not be covered by insurance. I had a recent
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