Autologous Hematopoietic Stem Cells Transplantation and its Current Role in Multiple Sclerosis Treatment

Multiple sclerosis (MS) is the most frequent autoimmune disorder of the central nervous system in our geographical region. The disease can lead to variable degree of neurological disability according to aggressiveness of MS course itself, early treatment initiation and its invidividual efficacy. In about 3% of the patients MS course can be classified as malignant with severe attacks from the beginning of the disease and rapid accumulation of neurological disability despite adequate treatment. In such cases the treatment with high-dose immunoablation with autologous hematopoietic stem cells support (ASCT) should be considered. The treatment rationale comprises the effort of autoaggressive immune system elimination by high-dose cytostatic treatment followed by return of patients' own hematopoietic stem cells as resources for a new immune system. The aim is to enable reconstitution of potentially less autoaggressive immune system. The progression free survival 10 years in 47% of the patients has been achieved in the first ASCT group with the longest follow-up since 1995 - great result in comparison with any other currently available MS drug. More than 400 patients worldwide have been treated with ASCT procedure so far, Nowadays optimal indication for ASCT treatment involves highly active MS within first five years of the disease and ability to walk at least 100 metres without aid, Despite its risks (including 2.3% mortality) ASCT presents promising treatment for malignant MS with poor prognosis also in the Czech Republic, where ASCT research - still so needful and essential - started in 1998.