HSCT: what to expect
If you're considering having HSCT, we recommend you talk to your neurologist about whether it's the right treatment for you.
Am I eligible for HSCT?
HSCT is available on the NHS for people who meet very specific medical criteria. These are based on the European Group for Blood and Marrow Transplantation (EBMT) guidelines for HSCT, but may differ a little from centre to centre.
You need to have evidence of active inflammation (new MRI lesions) for doctors to refer you for treatment on the NHS.
Right now, HSCT is only recommended after one or more disease modifying therapies (DMTs) have failed. There are a number of very effective DMTs available for people with MS.
As it's an intense procedure with high risks, it's not routinely considered.
What are the risks of HSCT?
HSCT has seen some very positive results, but it is an aggressive treatment. This means it comes with high short and long-term risks and complications. These include:
- an increased, long-term risk of developing infections
- an increased risk of developing cancer and autoimmune conditions, such as thyroiditis
- early menopause
- fertility problems.
The chemotherapy has its own side effects too. These include an increased risk of bleeding and bruising, fatigue, loss of appetite and hair loss.
According to a European register, one or two in every 100 people (1.3%) having HSCT have died as a result of the treatment.
What are the benefits of HSCT?
HSCT has been shown to reduce relapses for some people with, mainly, relapsing MS.
Some people experience more stable or improved symptoms, or an improved level of disability. Although these improvements do not always last.
What happens during HSCT?
Anyone being considered for HSCT will first be reviewed by the specialist team at the treatment centre.
The treatment begins with doses of chemotherapy and injections to encourage your stem cells to move from your bone marrow into your blood. When there are enough stem cells in your blood, they will be removed and stored for later in the procedure.
Chemotherapy is then given as an infusion to wipe out your immune system. This part of the procedure is likely to take several days.
Finally, stem cells are transplanted back into the blood by a drip to help regrow the immune system. This usually takes place a couple of days after the chemotherapy, once the drugs have cleared your system.
The stem cells start making new blood and immune cells within 10 and 30 days of the transplant. As your immune system isn't working yet, you are more likely to get infections during this period. You're usually put on antibiotics and transfusions to support you.
Anyone having HSCT also has to spend around a month in an isolation room while their immune system rebuilds. This isolation can be lonely and challenging.