Revolutionary treatment for patients with Multiple Sclerosis
MS and Autologous Haematopoietic Stem Cell Transplantation (AHCST)
Multiple sclerosis (MS) affects around 1.3 million people world-wide and over 100,000 in the UK alone. Though most patients present with the familiar relapse-remission pattern, more than 80% will go on to develop progressive disability with 40% requiring a wheelchair 10 years after diagnosis.
AHSCT for patients with MS offers the most exciting treatment yet for those in whom first line therapies have not worked: quite possibly a paradigm shift in the fight against this debilitating condition.
More than 1100 AHSCT procedures have been performed in Europe and several thousand around the world. Although it has been available for some time it is only recently that we have accumulated enough convincing clinical data to suggest that AHSCT may have sustained benefit in halting the progress of MS and in some cases reversing disability. The clinical credibility of AHSCT as a treatment for MS has been enhanced with the presentation of the initial results of the influential MIST study which confirms the superiority for this therapy over best available alternatives.
In place of the current drug-centred immunotherapy treatments offered for patients who have not responded to 1st line therapy, this one-off intensive therapy offers a 70% chance of stability (as defined by No Evidence of Disease Activity (NEDA) criteria) over three years, compared with approximately 30% on intensive immunotherapies. The procedure is rigorous but it is only required once – if successful, after 3 months, patients may become completely anti-MS drug-free which represents a significant improvement in quality of life.
London Bridge Hospital is ideally placed to offer this state of the art therapy, overseen by one of the pioneers in AHSCT for auto-immune disease in the UK, Dr Majid Kazmi and his highly-experienced team. Set in an accredited clinical environment and in the comfort of the first-class facilities, AHSCT is primed to transform the lives of patients with MS.
“We’re almost at a tipping point where in the next five years we would probably be able to confidently say that no patient with MS should end up in a wheel chair – and I think that is a game changer – no other treatment to date has been shown to do that.”
Dr Majid Kazmi, Consultant Haematologist
The London Bridge Hospital AHSCT Programme
London Bridge Hospital was one of the first centres to run an AHSCT treatment programme for patients with relapsing MS who have had little or no success with disease modifying therapies (DMTs) and for those with primary, progressive MS. Stem cell transplantation treatments of this kind is a highly specialised procedure with significant risk to the patient. It requires a relentless focus on quality, appropriate back-up expertise and support through the intensive component and prolonged recovery period. They can, however, produce striking results in terms of stopping symptoms in their tracks and in some cases reversing disability, backed up strongly by recent clinical research. This is why London Bridge Hospital took the decision to provide this treatment, still one of the few centres in the UK, and the only private hospital, to offer it.
Why have AHSCT at London Bridge Hospital?
The London Bridge Hospital stem cell transplantation programme is led by Consultant Haematologist Dr Majid Kazmi, who has carried out over 70 AHSCTs at Guy’s and St Thomas’ NHS Foundation Trust & Kings College Hospital NHS Trust. He is one of Europe’s leading experts in this area with clinical experience going back to 2005 and a considerable body of published work on stem cell transplantation to his credit.
Our programme is fortunate to have a dedicated team of consultants, clinical nurse specialists (CNS), pharmacists, physiotherapists, occupational therapists, and dietitians with extensive experience in this field. The transplant unit is JACIE accredited demonstrating its focus on quality and safety.
If you have MS and would like to learn more about AHSCT and whether it might be right for you, it will be necessary to get a referral for an appointment with one of our expert Consultant Neurologists. At London Bridge Hospital our Consultant Neurologists are leaders in the field of AHSCT and you will be seen by either Dr Eli Silber or Dr Ben Turner for confirmation of your diagnosis.
A multidisciplinary approach to your treatment
Once you have been assessed by our neurologists, your case will be reviewed by the London MS-AHSCT Collaborative Group, a panel comprised of both NHS and private hospital consultants with neurological and haematological clinical expertise. Together, these specialists will consider the suitability for any patient requesting a stem cell transplant for MS.
If you are deemed suitable by the panel, you will then be referred to Dr Majid Kazmi. He will assess your physical fitness for the procedure and present your case to London Bridge Hospital’s multidisciplinary team (MDT) to review against our stem cell transplant criteria and decide whether to move to treatment.
London Bridge Hospital has been rated ‘Outstanding’ by the CQC and our Private Care at Guy’s unit is JACIE accredited, the certification of which ensures a transplantation environment of the very highest standard. Set near the River Thames, close to The Shard outpatients, your stay is guaranteed to be supremely comfortable in immaculate surroundings.
What to expect from your AHSCT treatment
Once you have been confirmed suitable for treatment, a haematology nurse specialist will coordinate your care, arranging appointments and working together with you to ensure that your treatment goes smoothly. They will also be available to answer any questions that you or your family might like to raise.
It is important to realise that AHSCT is a staged procedure which will take place over the course of approximately 18 weeks on average.
Stage 1 Cell Collection
Mobilising and collecting your stem cells
Stem cells usually reside in low numbers in the bone marrow. We can increase the numbers of stem cells and encourage them to come out into the blood through a process called mobilisation. This involves chemotherapy, followed by injections of growth factor (G-CSF) under the skin. For MS patients, this requires an initial two-night stay for the cyclophosphamide infusion. This procedure will take place at London Bridge Hospital, in our JACIE accredited private facility.
Collecting your stem cells
The next step is to harvest your stem cells. You will be given the growth factor drug injection (G-CSF) under the skin for about ten days to stimulate your body to produce more stem cell numbers and release them from the bone marrow into the peripheral blood.
They will be collected using a process called Peripheral Blood Stem Cell Harvesting (PBSCH) or apheresis. For the PBSCH, a cannula is inserted into each arm. Blood is removed from you, circulated in an apheresis machine, the stem cells are extracted and your blood is then returned to you via the other arm.
This usually takes place as a single day case procedure, although some patients may require additional days to enable enough stem cells to be collected for transplant.
Your stem cells will be processed at a specialist laboratory, frozen and then stored in liquid nitrogen. These cells can be kept for up to five years. After harvesting, you will be given at least a 3-4 week period for your body to recover before being admitted for your transplant.
Stage 2 ~ Autologous Haematopoietic Stem Cell Transplantation
For the transplant itself, you will be admitted to a private, en-suite room at London Bridge Hospital, Private Care at Guy’s, where you will stay for the duration of your treatment. This will last typically four weeks depending on your diagnosis and clinical needs.
For the procedure, you will have a central venous catheter inserted, which is used to reinfuse your cells. You will then receive a high dose of chemotherapy and immunotherapy, which is known as the preparative or conditioning regime, and takes six days to complete.
Your haematology CNS and attending consultant will visit you daily throughout your treatment. Our nursing team have been specifically trained to care for stem cell transplant patients. You will also be seen by our specialist dietitians, who will oversee your overall diet and nutrition, and our physiotherapists will assist in keeping you active.
Getting your stem cells back: ‘Day Zero’
Your stem cells will then be thawed and reinfused by our specially trained nurses. The day that you receive your stem cells back is known as ‘Day Zero’. This process will take place in your private patient room and the time that it takes will depend on how many bags of stem cells you are having reinfused. Generally, this takes an afternoon. The stem cells are reinfused similarly to a blood transfusion.
Engraftment and recovery
After reinfusion, the stem cells will find their way back to the bone marrow and will start to divide and repopulate the bone marrow and the immune system. This is called the aplastic phase, where it’s likely you will be placed in isolation as you are most at risk from infection.
The engraftment period occurs when the blood cells start to recover to a safe level. This occurs over a few days and it is usually the white blood cells (neutrophils) which will recover first. Most patients will stay in hospital for around three weeks from ‘Day Zero’, however this can vary depending on recovery rates. You will be discharged when it is medically safe for you to be at home, although full recovery post-AHSCT will take many weeks.
Stage 3 - After the transplant
Once you have been discharged from hospital, you will continue to be closely monitored through regular blood tests and scans, initially at least weekly for the first month, then fortnightly for an additional month, then at increasing intervals as dictated by your clinical condition.
A CNS is on hand to provide any support should you require it. You will also be given detailed information on post-transplant care, including any signs and symptoms to look out for. Contact details for the team are also provided.
Criteria for treatment
Not every patient with MS will be suitable for AHSCT treatment. To determine whether you are or not, you must meet the following criteria:
• Aged 18 – 65.
• A diagnosis of MS within the last 15 years.
• A firm diagnosis of MS according to McDonald’s criteria
• For those with primary, progressive MS (PPMS) a lumbar puncture confirming oligoclonal bands within the spinal fluid.
• If you have relapsing MS, documentation that disease modifying drugs have not worked after six months of treatment. This should be evidenced by on-going relapses, increased MRI activity or progression of MS by increase in mobility score (EDSS).
• Mobility score (EDSS) should be between 0 – 6.5 (walking with bilateral assistance such as two sticks or a rollator frame).
• Approval from London MS-AHSCT Collaborative Group
If you meet these criteria then treatment can be considered.
• We may consider on a case-by-case basis patients who have not taken or are unwilling to take a high efficacy DMT for a private transplant (currently not funded through the NHS).
How do I get referred?
If you would like to receive AHSCT treatment, your Consultant Neurologist or GP should provide us with the following information:
• Documented diagnosis of MS by a neurologist with the date of the diagnosis.
• A record of the ability to walk 20 metres without resting or needing, at most, bilateral assistance with two sticks or a rollator frame.
• If you have relapsing MS, documentation to show that treatment with one of the high- efficacy disease modifying drugs has been unsuccessful.
• If no high-efficacy DMT has been tried, the reason for moving directly to AHSCT needs to be recorded.
• MRI scans showing activity within the last 12 months compared to a comparative scan that was done in the previous two to three years. The radiology reports from both time frames should be included with the written referral.
Get in touch
Self-pay packages are available on request. Insurance companies are now looking at this treatment and may be covered under some policies.
If you would like to learn more about AHSCT for MS patients, a service which we offer here at London Bridge Hospital, don’t hesitate to get in touch – we’re happy to talk you through it.
0207 234 2009
Published: March 19, 2018