The London AHSCT Collaborative group (neurologists, haematologists) have been transplanting MS patients for several years now at King’s College Hospital, south London and since 2016 at Hammersmith Hospital, west London.
AHSCT means ‘autologous’ (your own, rather than a donor’s stem cells) haematopoietic (in the blood stream) stem cell transplant. More commonly known in the UK as a bone marrow transplant, HSCT is the more modern term as the stem cells are now harvested from the peripheral blood after being mobilised through G-CSF injections, rather than drilling directly into the bone marrow. The procedure is largely chemotherapy to ablate the faulty, over active immune system, supported with stem cells to help build up the new immune system more quickly.
In January 2016 the group published their eligibility and referral criteria on multiple-sclerosis-research.blogspot.com, a research blog from clinicians and researchers at the Royal London / Barts Hospital.
The criteria is largely looking for evidence the MS is in the inflammatory stage rather than the degenerative phase:
- primary progressive MS: oligoclonal bands in cerebrospinal fluid (lumbar puncture)
- secondary progressive MS: activity shown on gadolinium contrast MRI (enhancing /active lesion or new lesion), or two new T2 / flair lesions in space of past 12 months. Check both brain and spine in a gadolinium contrast MRI.
- relapsing remitting MS: must ALSO have failed higher efficacy drugs Tysabri (natalizumab) or Lemtrada (alemtuzumab / CAMPATH) over 6 months of treatment minimum, with a relapse / MRI activity/ EDSS progression
- age 18 – 65
- able to walk, needing at most bilateral assistance to walk 20m without resting
- expanded disability scale score (EDSS) less than 6.5 – here is a good EDSS calculator
A GP can refer their MS patient to the below neurologists who will take recommended cases to the multi-disciplinary team (MDT) for review. The local area authority is not responsible for funding the HSCT procedure, this funding comes from a separate pot.
In alphabetical order:
- Dr Omar Malik – Charing Cross Hospital
- Dr Richard Nicholas – Charing Cross Hospital
- Dr Eli Silber – King’s College Hospital
- Dr Ben Turner – Barts and The London Hospital
If approved, a referral will be provided to haematologists Dr Majid Kazmi at King’s College Hospital or Dr Ian Gabriel at Hammersmith Hospital.
The haematologists run the haematopoietic stem cell transplantation procedure and will meet patients to review full medical history and provide advice and clearance to proceed to an admission date.
The collaborative group has said its view is that it is an ‘exceptional therapy’ and note it has not been green lighted by NICE for wider user.
The London hospitals use non-myelobative chemotherapy (cyclophosphamide + ATG).
Dr Paolo Muraro from Charing Cross Hospital co-chairs the Collaborative Group. In 2016 he reported in journal Multiple Sclerosis ‘no evidence of disease activity’ (NEDA) is more easily attainable in HSCT than in disease modifying treatments.
NEDA patients at 2 years (ranging from 78% to 83%) and also at 5 years (ranging from 60% to 68%). This is even more relevant when considering that MS patients who underwent aHSCT are much more active than patients usually enrolled in clinical trials. The emerging evidence of the efficacy of this therapeutic approach in early aggressive and treatment-resistant RRMS calls for the organization of a randomized comparative trial to fully evaluate the risk-benefit profile of aHSCT in patients with highly active MS not responding to DMTs.
The randomised comparative trial mentioned is awaiting NHS funding, but will look for 180 participants and will compare against higher efficacy DMDs.
The current treatment available in London is off-trial.
This option has been alluded to on the UK MS Society’s website, however it advises MSers to speak to their own neurologist, who likely will not know about the treatment happening in NHS hospitals outside of the MIST trial currently being undertaken at Sheffield Hallam University Hospital.
The MS patient only needs a GP referral to one of the above neurologists and their medical history, though would be wise to have access to previous MRI scans and notes.
A patient blog by Occupational Therapist Triona Bromwell is a great resource detailing her treatment at King’s College Hospital in 2015.