Stem cell transplants may delay disability progression longer than MS medications

In patients with active secondary progressive MS, hematopoietic stem cell transplants may delay disability longer than some MS medications, researchers reported in Neurology.

Uncontrolled evidence suggests that autologous hematopoietic stem cell transplants can be effective in those with active secondary progressive MS, Matilde Inglese, MD, PhD, of the University of Genoa in Italy, and colleagues wrote.

“Hematopoietic stem cell transplants have been previously found to delay disability in people with relapsing-remitting MS, but less is known about whether such transplants could help delay disability during the more advanced stage of the disease,” Inglese said in a press release from the American Academy of Neurology.

According to the release, most people with MS are first diagnosed with relapsing-remitting MS, but many eventually transition to secondary progressive MS, which does not have wide swings in symptoms but rather a slow, steady worsening of disease.

Inglese and colleagues compared the effect of autologous hematopoietic stem cell transplants with those of other anti-inflammatory disease-modifying therapies among those with secondary progressive MS.

The researchers collected data from the Italian Bone Marrow Transplantation Study Group and the Italian Multiple Sclerosis Register. Eligible patients had treatment started after diagnosis of secondary progressive MS. Disability worsening was assessed through a 6-month confirmed disability progression, according to the Expanded Disability Status Scale (EDSS).

Seventy-nine patients treated with autologous hematopoietic stem cell transplants and 1,975 patients treated with other DMTs were matched.

The time to the first confirmed disability progression was significantly longer in transplant patients (HR = 0.5; 95% CI, 0.31-0.81), with 61.7% of transplant patients free from disability progression at 5 years. Also, the EDSS time trend over 10 years was higher in patients treated with other DMTs compared with those who received transplants.

In addition, patients who received stem cell transplants were more likely to experience a sustained disability improvement — 34.7% of patients maintained an improvement 3 years after transplant compared with 4.6% of patients who received another DMT.

“Our results are encouraging, because while current treatments for secondary progressive MS have modest or small benefits, our study found stem cell transplants may not only delay disability longer than many other MS medications, but they may also provide a slight improvement in symptoms,” Inglese said in the release.

However, while the study results may be encouraging, Inglese notes they are not applicable to patients with secondary progressive MS who do not have signs of inflammatory disease activity.

Reference:

Stem cell transplants may delay disability longer than some MS medications. https://www.aan.com/PressRoom/Home/PressRelease/5037. Published Dec. 21, 2022; Accessed Jan. 3, 2023.