What Is HSCT?
HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) for MULTIPLE SCLEROSIS
Hematopoietic stem cell transplantation (HSCT) involves the transplantation of a person's own stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord. It has traditionally been performed for patients with certain cancers, however over the past decade it has also started being employed for autoimmune diseases such as MS.
There are several steps involved in the HSCT process:
Step 1: Mobilization
Mobilization is achieved by twice daily injection of G-CSF (granulocyte colony stimulating factor). G-CSF encourages the bone
marrow to over produce stem cells which in turn are released into the blood stream.
Step 2: Apheresis
Apheresis refers to the process where the stem cells are collected from your body. To acheive this, blood is withdrawn via a catheter and circulated through a machine which in turn separates the individual components contained within. This process typically lasts about 4 hours. The minimum stem cell count required is 2 million cells per kg of body weight. After collection, these cells are taken to a blood bank where they are frozen until they are to be returned to the body.
Step 3: Chemotherapy
The current immune system in the body of someone with an autoimmune disease is defective in that the immune cells are attacking ones own body. These are called autoreactive cells. The same premise holds true for all autoimmune diseases such as MS, lupus, rheumatoid arthitis, scleroderma, and many more. During this procedure 200mg/kg of cyclophosamide will be used over a 4 day period to effectively wipe out or suppress the old autoreactive immune system.
Step 4: Stem Cell Transplant
The term transplant is likely overdramatic for this stage. This is where the individual's own stem cells from step 2 are returned to the
body. The purpose of these cells at this point is to regenerate the immune system. It can be thought of re-installing the software on a computer after the hard drive was erased.
Step 5: Isolation and Engraftment
Due to the effects of the chemotherapy, the individual must be kept in a sterile environment for a period of time. Remember, the old immune system has been erased and it takes about 2 weeks for the new immune system to regenerate from the stem cells.
Once the stem cells return to the bone marrow and recover the new immune system, this is termed engraftment.
Step 6: Recovery
Recover occurs over a period close to 2 years following transplantation. That being said, some MS patients have continued to see improvements for many years post-transplant. In addition to halting the progression and activity of their MS, many of HSCT patients see a reversal of many of their pre-existing symptoms. Earlier treatment in the course of the disease appears to have a higher success rate than those who have more long standing and progressive disease.
HEMATOPOIETIC STEM CELL TRANSPLANT (HSCT) for MULTIPLE SCLEROSIS
Hematopoietic stem cell transplantation (HSCT) involves the transplantation of a person's own stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord. It has traditionally been performed for patients with certain cancers, however over the past decade it has also started being employed for autoimmune diseases such as MS.
There are several steps involved in the HSCT process:
Step 1: Mobilization
Mobilization is achieved by twice daily injection of G-CSF (granulocyte colony stimulating factor). G-CSF encourages the bone
marrow to over produce stem cells which in turn are released into the blood stream.
Step 2: Apheresis
Apheresis refers to the process where the stem cells are collected from your body. To acheive this, blood is withdrawn via a catheter and circulated through a machine which in turn separates the individual components contained within. This process typically lasts about 4 hours. The minimum stem cell count required is 2 million cells per kg of body weight. After collection, these cells are taken to a blood bank where they are frozen until they are to be returned to the body.
Step 3: Chemotherapy
The current immune system in the body of someone with an autoimmune disease is defective in that the immune cells are attacking ones own body. These are called autoreactive cells. The same premise holds true for all autoimmune diseases such as MS, lupus, rheumatoid arthitis, scleroderma, and many more. During this procedure 200mg/kg of cyclophosamide will be used over a 4 day period to effectively wipe out or suppress the old autoreactive immune system.
Step 4: Stem Cell Transplant
The term transplant is likely overdramatic for this stage. This is where the individual's own stem cells from step 2 are returned to the
body. The purpose of these cells at this point is to regenerate the immune system. It can be thought of re-installing the software on a computer after the hard drive was erased.
Step 5: Isolation and Engraftment
Due to the effects of the chemotherapy, the individual must be kept in a sterile environment for a period of time. Remember, the old immune system has been erased and it takes about 2 weeks for the new immune system to regenerate from the stem cells.
Once the stem cells return to the bone marrow and recover the new immune system, this is termed engraftment.
Step 6: Recovery
Recover occurs over a period close to 2 years following transplantation. That being said, some MS patients have continued to see improvements for many years post-transplant. In addition to halting the progression and activity of their MS, many of HSCT patients see a reversal of many of their pre-existing symptoms. Earlier treatment in the course of the disease appears to have a higher success rate than those who have more long standing and progressive disease.