Can a Stem Cell Transplant Help?

In 2000, just 4 years after being diagnosed with an early and aggressive form of multiple sclerosis, Jennifer Molson began to relapse. Switching to a new, higher dose drug did not bring relief.

“In 2001, I stopped working,” she recalls. “My partner [now husband], Aaron, bathed me, dressed me, cut all my food. I had no chest down feeling, bladder control issues, bowel control issues. I remember making a bowl of cereal, putting it on my walker, and dropping it on the floor. And I just sat on the floor and cried.

A neurologist at the hospital in Ottawa, Canada, where Molson was receiving treatment, suggested that she participate in a clinical trial to see if a stem cell transplant could bring her condition under control.

“The doctors weren’t trying to give me my life back; they were trying to stop my disease activity, ”Molson says.

The procedure, known as a hematopoietic stem cell transplant, uses high-dose chemotherapy to bypass your inactive immune system. Then you get a transplant of hematopoietic stem cells, which are found in the bone marrow. The goal is to restore more normal immune function, says Jeffrey Cohen MD, director of the Experimental Therapy Program at the Mellen Center for Multiple Sclerosis Treatment and Research at the Cleveland Clinic.

Worth the risk

A stem cell transplant can work very well, but it comes with risks. In addition to the side effects like nausea, hair loss, and infertility that are common with chemotherapy, there is a low risk of fatal complications.

The latest research shows that for more than 20 years, autologous hematopoietic stem cell transplantation, or aHSCT, has been an effective treatment for people with highly active relapsing-remitting MS who do not respond well to medication. It could also be useful for treating progressive forms of the disease.

At the Cleveland Clinic, Cohen is leading a clinical trial to show that the procedure, which costs over $ 150,000 and is rarely covered by insurance, is a safe and cost-effective approach to treating MS.

In some comparisons, aHSCT appears to work better than the more potent drugs available, Cohen says. Stem cell transplants have much higher remission rates than available drugs.

People with MS who get stem cell transplants could experience “powerful disease-fighting benefits” that last up to 10 years without the need for additional medications, he says.

Molson knew the risks were high, but, she says, “I had no choice. I had tried everything else; it was my last hope.

Continued

Slow improvements

She received the stem cell transplant in May 2002. She was only the fifth person in Canada to undergo this procedure.

As part of the treatment, Molson spent a month in the hospital, then returned daily for blood work to see if she needed blood transfusions. Its side effects ranged from severe nausea to infections of the bladder and kidneys. Chemotherapy also put her in menopause at 27.

In the months following the stem cell transplant, she began to notice subtle changes. She could shop for groceries without extreme fatigue and walk to the mailbox without using a cane to balance herself. Three years after the stem cell transplant, she started driving again and returned to work.

“It wasn’t like I had a stem cell transplant and started running down the hall,” she says. This is not how it worked. “It was those gradual accomplishments, those little steps. That’s when the doctors started to realize that something cool was going on, that they were starting to see patients recovering. “

For Molson, small steps led to big leaps. She went from using a wheelchair and a walker to swimming, kayaking and downhill skiing.

“I was doing things that I never, ever thought in a million years I could do again,” she says.

Life changer

As part of the research study, Molson had an MRI scan every 6 months for 10 years. The final MRI, which was in 2012, showed no new disease activity. She has not taken any disease modifying drugs since the stem cell transplant almost 20 years ago.

“I have been in lasting remission for 18 years,” she says. “I lived longer in this lasting remission, than what I actually did with my period of active illness.”

Although Molson has had life-changing results from stem cell transplantation, treatment is not a one-size-fits-all approach for all people with MS. Cohen says there are still many unanswered questions. And he advises against seeking treatment at commercial stem cell clinics.

Molson is also cautious when telling others about stem cell transplants to treat MS.

“I can’t say enough about it, it brought me back to life,” she says. “But the treatments that are available now, compared to when I had my transplant, are so much better and different and, as my neurologists have said, ‘Why would you want to use a nuclear bomb when you don’t need it? ‘ It’s not for everyone.

Sources

SOURCES:

Jennifer Molson, patient, Calgary, Alberta, Canada.

Jeffrey Cohen MD, Director, Experimental Therapy Program, Mellen Center for Multiple Sclerosis Treatment and Research, Cleveland Clinic, Cleveland, OH.

MS Society: “HSCT: What to Expect.”

A bone marrow transplant: “Autologous Hematopoietic Stem Cell Transplantation and Other Cellular Therapies in Multiple Sclerosis and Immune-Mediated Neurological Diseases: Updated Guidelines and Recommendations from the EBMT Autoimmune Disease Working Group (ADWP) and Committee on ‘joint accreditation of EBMT and ISCT (JACIE). “


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