Stem Cell Treatment

“Stem cell” treatments can be quite varied, but for the procedure called autologous hematopoietic stem cell transplantation (aHSCT), it involves removal of the thought-to-be faulty immune system using chemotherapy and growing a new one from a person’s own “stem cells”. The newly developed immune system seems to lack the errors that led to MS. AHSCT is a one-time procedure and for some people it can significantly reduce and potentially stop MS disease activity. 

The aHSCT protocol (treatment plan) for MS is not the same across the world and even within Canada. This is due to the varied expertise of transplant specialists and their preference for using specific chemotherapies. The chemotherapy is required to remove the immune system, which is causing MS. Then, using a person’s own stem cells that are previously obtained and frozen, it is possible to regrow a new immune system that no longer attacks the central nervous system.  

AHSCT is the only stem cell treatment that Canadian MS specialists and health organizations consider supported by strong, well‑established evidence for MS. 

Some private clinics across Canada claim to offer other stem cell treatments for MS, but these are not supported by experts or research. 

There are several sites that accept referrals for people who are eligible for aHSCT. Speak to your neurologist for more information about this treatment option. If your neurologist thinks that you might benefit, and are eligible for this procedure, they can send a referral to one of the following sites for consideration: 

• The Ottawa Hospital – General Campus MS Centre
• Foothills Medical Centre in Calgary
• Le Centre hospitalier de l'Université de Montréal (CHUM)
• Le Centre hospitalier de l'Université de Québec-Université Laval (CHU). 

Currently, aHSCT for MS is only available at select sites in Canada because it needs specialized teams, equipment, and careful monitoring after the transplant. Because of this, most hospitals aren’t set up for aHSCT yet, but Canada’s Drug Agency (CDA) has created guidance for provincial healthcare systems  on what is needed to make this treatment more widely available in the future.  

There are also ongoing clinical trials around the world looking at the safest and most effective transplant protocols; long-term treatment effects on the immune system and disease activity; and how aHSCT outcomes compare with outcomes from high-efficacy MS disease modifying treatments (DMT).

Step 1: You take medication that moves your stem cells from your bone marrow into your bloodstream.

Step 2: The stem cells are collected from your blood.

Step 3: The stem cells are frozen and safely stored.

Step 4: You receive chemotherapy to remove disease causing immune cells.

Step 5: Your stored stem cells are thawed and given back to you through a vein.

Step 6: Over time, your new immune system rebuilds from those stem cells while you are closely monitored.

After the transplant, you will be closely monitored by the transplant and MS team. You will need to stay in or near the city where the procedure is done for several months so your care team can monitor you safely. You will need to have a caregiver with you after the procedure.

Follow-up usually includes:

• Regular medical and neurological exams
• MRI scans to monitor MS activity
• Blood tests to track immune system recovery
• Monitoring for infections or other treatment side effects
• Timely re-vaccination for all conditions as immunity can be wiped out along with the removal of the old immune system
• Support for physical and emotional recovery

Follow-up is needed to:

• Make sure your immune system is rebuilding safely
• Check that MS remains inactive
• Manage any complications early

The benefits of aHSCT are different for each person. Some people who have had aHSCT have gone into long-term remission. Some have had their symptoms go away. Most people experience long-term relapse and MRI-free periods.

The main risk of aHSCT comes from chemotherapy treatments. Wiping out the immune system puts people at risk for infections that can be life-threatening. Factors that increase the risk of life-threatening side effects after aHSCT include:

• Older age
• Greater level of disability
• Certain co-morbid health conditions, like heart or lung disease

Chemotherapy will likely cause infertility in women and also possibly in men. If you might want to have children in the future, your healthcare team may suggest saving your eggs or sperm before treatment. Overall, advances in transplant care have greatly improved the safety of aHSCT. 

For people who are eligible for aHSCT, the cost of the procedure is covered through provincial health insurance. However, personal expenses, like travel, temporary accommodation (outside of the hospital), and other day-to-day costs, are not covered.

You must have valid provincial health insurance to receive care at any Canadian site, and some sites will only accept individuals with provincial health coverage from the same province.

If you’re approved for aHSCT and need to temporarily move for treatment and financial assistance is needed, talk with your healthcare team. There may be private insurance options or hospital-based financial assistance programs they can tell you about.

Start by talking to an MS specialist with knowledge of aHSCT. Discuss the benefits and risks of aHSCT for your MS, as well as other potential disease modifying therapy options. Because aHSCT includes suppressing your immune system, there is a risk of serious infection. Studies show that aHSCT can be safe and effective in people who:

• Have relapsing-remitting MS. Research shows that aHSCT is most effective for highly active RRMS because it targets ongoing inflammation. AHSCT can’t regrow damaged nerves or repair damaged myelin. But by eliminating the inflammation that is impairing repair or regrowth, some recovery may occur. 
   
• Are younger than age 50. Older people can have weaker immune systems and other health conditions (like heart disease or other age-related diseases) that may put them at higher risk for complications from aHSCT.
   
• Were diagnosed with MS less than 10 years ago. People who have had the disease longer may have increased disability, which can make the aHSCT procedure riskier. There is also more accumulated permanent damage.
   
• Haven’t optimally responded to high-efficacy DMT. This means that even with high-efficacy treatment, they continue to have new lesions and ongoing relapses. High-efficacy DMTs include alemtuzumab (Lemtrada®), cladribine (Mavenclad®), natalizumab (Tysabri®), ocrelizumab (Ocrevus®), ofatumumab (Kesimpta®), rituximab (Rituxan® and biosimilars).
  
   

AHSCT treatment plans aren’t the same everywhere. Centres outside of Canada use different medications and follow a variety of treatment approaches, some of which have limited or unknown evidence in MS. 

People who are thinking about travelling outside of Canada for aHSCT, or any medical treatment, are strongly encouraged to learn as much as they can about the treatment being offered and talk with their healthcare team before making any decisions.