About HSCT

What is HSCT?
Hematopoietic Stem Cell Transplantation (HSCT) is a treatment that is gaining momentum worldwide. HSCT is the transplantation of multipotent hematopoietic stem cells, usually derived from bone marrow, peripheral blood, or umbilical cord blood. HSCT involves the intravenous (IV) infusion of autologous or allogeneic stem cells to re-establish hematopoietic function in patients whose bone marrow or immune system is damaged or defective. It is not actually new to the medical world, while seeming revolutionary to those who have never heard of it before. HSCT has been carried out by hematologists around the world for over 50 years as a treatment for cancer. This procedure has also been performed for over 20 years to treat a wide range of hematologically-based autoimmune disorders. Demonstrating a growing popularity in this treatment based on clinical results over time, over 1600 patients, worldwide, have been treated with HSCT for MS. This treatment is scientifically proven to restore immune self- tolerance, and also to provide the patient with an enduring curative outcome after only one single procedure. HSCT can offer all MS patients, especially in the early stages of the disease, a chance for a life free from MS progression.

How does HSCT work?
HSCT works by deleting the body’s B- and T-lymphocyte immune system memory. This treatment inactivates the patient’s autoimmunity (which causes the patient’s MS), and results in the restoration of immune self tolerance. The ‘resetting’ of the immune system halts the underlying MS disease activity and progression. The stem cells alone don’t provide the curative effect of this treatment. They only act for the purpose of re-establishing the immune system which has been destroyed as part of the chemotherapy regime. The stem cells do not cure the patient of their MS, but rather rescue the patient from possible death as the rest of the chemotherapy is given. It is the high dose of chemotherapy that destroys the patient’s auto-immune disease, not the stem cells. The body then has the opportunity to either repair or compensate for existing nerve damage, after the reset is fully achieved.

What does the treatment involve?
The treatment performed by Dr Denis Fedorenko and Team at The A.A. Maximov Hematology and Cell Therapy Department of the National Pirogov Medical Surgical Centre takes around 35 days and includes inpatient care for the entirety of the treatment.

 

What will be happening to me….
Following admission there will be a few days of pre-testing (which hopefully I will pass with flying colours) and then once approved I’ll move into the treatment phase……..

Mobilisation
Twice a day, for four days, at 11pm and 3am, I will receive Neupogen injections  to stimulate stem cell growth.  This process, which causes greater numbers of stem cells to be present in the blood stream, is known as mobilisation.   The most common side effect of mobilisation is mild-to-moderate bone pain or fever and to help with this I may also receive intravenous steroids. 

Apheresis (Collection of Stem Cells)
Apheresis is the process of collecting the additional stem cells produced during the mobilisation phase.  The aim is to achieve a collection greater than 2 million stem cells per kilogram of body weight.  90% of patients reach this goal in one sitting, which is between four and six hours, but if this goal is not reached apheresis will continue the following day.

During the apheresis process, blood is withdrawn via an intravenous catheter and circulated through a cell-separating machine, similar to a dialysis machine.  This machine separates and collects the stem cells, along with some white blood cells, red blood cells, and platelets.  The remaining blood cells are returned at the same rate as they are removed.  There is only a small amount of blood, approximately several cups, in the separator machine at any one time.

After apheresis, the stem cells are frozen and stored under special conditions until they are needed for re-transplantation. Apheresis is normally a painless procedure, however, back and hip pain have been reported. 

Chemotherapy
I will be given high doses of chemotherapy (Cyclophosphamide) for four days to completely destroy my immune system.   After the four days of chemotherapy, I will have a day of rest in preparation for the stem cell transplant.

Stem Cell Transplant
After my immune system has been destroyed by the chemotherapy, the stored stem cells will be given back intravenously.  The process is very much like a blood transfusion, with side effects such as chilling, nausea, fever, cough, flushing, headache, abdominal cramps or diarrhea.  The nurses will give me medication to decrease these effects as all attempts are made to make you as comfortable as possible.  This is a huge day as this represents “New Life” and becomes your “new” birthday!

Engraftment
For 7 to 10 days following the re-infusion of stem cells only doctors and nurses will be permitted to enter my room.  I will be in isolation with walls, floors, bedding, clothing, and eating implements cleaned with special solution daily. During this time the revamped stem cells are growing, engrafting, and new blood cells are being produced.  The new immune system that is beginning to grow will have no memory of the MS it previously carried.

Once blood counts have begun to rise I will be released from isolation, but remain in hospital until my levels are at an acceptable level.  During this time the doctors administer a dose of Rituximab, a drug that kills off specific autoimmune antibodies.

Recovery
For about six to twelve months after HSCT, the immune system is very delicate. Some patients find that their MS symptoms worsen due to the chemotherapy. It takes an average of twelve to twenty-four months to see the complete benefits of HSCT, however, some patients have continued to see improvement for up to five years post-transplant.

The following is a guide of the timetable of the procedure:
Days 1-3 - Testing
Days 4-7 - Stem cell mobilisation with steroids
Day 8 - Rest day
Day 9 - Apheresis
Day 10 - Rest day
Days 11-14 - Chemotherapy
Day 15 - Transplant Day
Day 16 - IV infusions and rest
Day 17 - Isolation begins
Days 18-22 - IV infusions
Day 23 - Engraftment
Days 24-28 - IV infusions
Day 29 - Rituximab
Days 30-35 - Rest and IV infusions

Information sourced from the many people that have undertaken HSCT Treatment before me

Dr Denis Fedorenko and the Pirogov Medical Surgical Centre