In Multiple Sclerosis (MS) the central nervous system (CNS) is attacked by one’s own immune system. It is responsible for damaging the brain and spinal cord. Dr Gaurav Dixit says that there is no cure for Multiple Sclerosis, however, some treatments can speed up the recovery time period.
How is Autologous Procedure used in Treatment of MS?
BMT is a medical procedure that is done to replace the damaged bone marrow (spongy material inside our bones, containing stem cells) with healthy bone marrow cells. The stem cells are responsible for producing blood cells like white blood cells, red blood cells and platelets. In this procedure, the stem cells are taken from the patient and reinfused after treating the patient with a high dose of radiation and chemotherapy.
Autologous Bone Marrow Transplant attempts to reboot the immune system. The hematopoietic (blood cell producing) stem cells that are derived from a person’s own bone marrow or blood are collected or stored prior to depletion of the immune system using chemotherapy drugs. Then the stored hematopoietic stem cells are reintroduced to the body. The new stem cells migrate to the bone marrow and over time reconstitute the immune system. However, it is still not approved as a standard treatment of MS by FDA. Despite some promising results in various studies, it is still considered as the “last resort therapy” for refractory MS.
How is Autologous BMT done?
The 5 steps involved in this procedure are:
- Conditioning – It is a short course chemotherapy given before actual stem cell infusion to destroy all bad cells. It lasts for about 1-10 days or more.
- Stem Cell Infusion- It is an Actual ‘Transplant’, which involves the infusion of stem cells (autologous or allogenic) by a central vein.
- Neutropenic Phase- This is the most critical phase post-transplant. During neutropenic phase the patient’s blood counts are very low, making them susceptible to infections. For this reason, they require special HEPA-filtered rooms with positive pressures to reduce the risk.
- Engraftment Phase- After a short neutropenic phase, lasting 10-14 days, the patient shows gradual recovery in their blood counts that can speed up the recovery period. By the end of the third week in autologous and 4 weeks in allogeneic transplant, the patient is ready for discharge.
- Post-Engraftment Period-Post-engraftment phase is another important phase, especially for allogenic transplant patients. Whereas in autologous transplant the focus is mainly on improving nutrition and general well-being, allogenic transplant may present itself with many issues like acute and chronic GVHD, for which they require close monitoring approximately for 6-12 months. In addition, patient requires immunization once he is off all immunosuppressive drugs to improve his immunity.