Autologous Hematopoietic Stem Cell Transplantation (AHSCT): Standard of Care for Relapsing–Remitting Multiple Sclerosis Patients

• Published in: Neurology and therapy Vol. 9; no. 2; pp. 197 - 203
• Main Authors: Bertolotto, Antonio, Martire, Serena, Mirabile, Luca, Capobianco, Marco, De Gobbi, Marco, Cilloni, Daniela
• Format: Journal Article
• Language: English
• Published: Cheshire Springer Healthcare 01-12-2020; Adis, Springer Healthcare
• Subjects: ASBMT; Autologous hematopoietic stem cell transplantation; Clinical option; Commentary; Costs; EBMT-ADWP; Guidelines; Internal Medicine; Medicine; Medicine & Public Health; Neurology; Clinical option; Costs; Multiple sclerosis; Standard of care; Autologous hematopoietic stem cell transplantation; EBMT-ADWP; ASBMT; Guidelines
• ISSN: 2193-8253; 2193-6536
• DOI: 10.1007/s40120-020-00200-9

Autologous hematopoietic stem cell transplantation (AHSCT) has been used in the treatment of highly active multiple sclerosis (MS) for over two decades. It has been demonstrated to be highly efficacious in relapsing–remitting (RR) MS patients failing to respond to disease-modifying drugs (DMDs). AHSCT guarantees higher rates of no evidence of disease activity (NEDA) than those achieved with any other DMDs, but it is also associated with greater short-term risks which have limited its use. In the 2019 updated EBMT and ASBMT guidelines, which review the clinical evidence of AHSCT in MS, AHSCT indication for highly active RRMS has changed from “clinical option” to “standard of care”. On this basis, AHSCT must be proposed on equal footing with second-line DMDs to patients with highly active RRMS, instead of being considered as a last resort after failure of all available treatments. The decision-making process requires a close collaboration between transplant hematologists and neurologists and a full discussion of risk–benefit of AHSCT and alternative treatments. In this context, we propose a standardized protocol for decision-making and informed consent process.