HSCT

Autologous Hematopoietic Stem Cell Transplant (HSCT)

Autologous HSCT is designed to reset a patient’s immune system using his or her own stem cells to halt the progression and activity of multiple sclerosis. 

 

HSCT involves the collection of a patient’s stem cells before high-dose chemotherapy is given to destroy the immune system.  After the high-dose chemotherapy, these stem cells, are returned to the patient intravenously to assist with the recovery of the destroyed immune system. This process results in a rebooting of the immune system and essentially, the immune system is reborn.

I will be undergoing the procedure in Moscow A.A. Maximov Department of Hematology and Cellular Therapy, National Pirogov Medical Surgical Center under the supervision of Dr Denis Federenko.

 

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 Solumedrol. 


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During the apheresis process, blood is withdrawn via an intravenous catheter and circulated through a cell-separating machine, similar to a dialysis machine.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.  Fingers crossed I get the 2 million in one sitting!!


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 diarrhoea.  The nurses will give me medication to decrease these effects as all attempts are made to make the 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 remains in hospital until my levels are at an acceptable level.  During this time Dr Federenko administers 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.