What is Multiple Sclerosis?

Multiple sclerosis is an autoimmune disorder which involves the nerve cells of the brain and spinal cord. In this condition, the patient’s own immunologic cells damage the nerve cells of the brain and spinal cord. This leads to the nerves eventually degenerating and the associated organs lose their function. It causes problems with vision, sensation, balance, and even movement of limbs.

What is BMT?

BMT or bone marrow transplant is a recent development to be specially used for Multiple sclerosis patients. Bone marrow is a yellowish structure present within the long bones which aid in the formation of blood cells. It is also called hematopoietic cells. The concept of bone marrow transplant is to replace the defective bone marrow of the patient with healthy bone marrow of a donor. Bone marrow transplant can be done with the harvest from the patient itself, which is collected prior to the intensive chemotherapy and then re-transplanted where needed. This is called autotransplantation or autogenous transplantation. It could also be harvested from a matched donor if the patient’s own cells are not viable. This is called allogenous transplantation.

How will Bone Marrow Transplant help Multiple Sclerosis?

In multiple sclerosis, the patient’s immune system has a defect. On performing hematopoietic stem cell transplant, the immune system of the patient with multiple sclerosis will get rebooted. It is generally done when the blood cells are completely depleted after a course of chemotherapy. The chemotherapy is performed in order to treat the condition.

Initially, the patient’s bone marrow cells are harvested and preserved. Then, the patient is subjected to intense chemotherapy for multiple sclerosis. Once the sclerosis is complete, the stored bone marrow harvest is then transplanted to the patient and the patient is given appropriate medications.

How is Bone Marrow Transplantation done for a case of Multiple Sclerosis?

Initially, the doctor conducts a thorough examination and case record of the patient. This includes recording of important medical history and general physical examination. Most of the diagnosis of Multiple Sclerosis takes place at this stage. The doctor will observe the affected site and check for signs to narrow down the diagnosis and treatment plan for multiple sclerosis. After this is done, tests are performed to confirm the diagnosis. Tests like ultrasound, x-ray, MRI, CT, complete blood picture are performed to deduce the result.

If the patient requires chemotherapy for multiple sclerosis, the doctor then educates the patient about the treatment options. One of the upcoming treatment modalities for multiple sclerosis is bone marrow transplant. Keep in mind that this is still an experimental procedure. The pros and cons of the procedure are explained to the patient.

If the patient of multiple sclerosis happens to choose hematopoietic bone marrow transplant, he is prepped for the procedure. He is given a dose of chemotherapies for a period of 10 days, which stimulate the bone marrow cells. Then, the cells are collected through the blood and preserved for later use.

The multiple sclerosis patient is hospitalized and a strong dose of chemotherapy is given so that the immune cells are destroyed. This is given approximately for a period of eleven days.

Once the immune cells are destroyed, the stored bone marrow harvest is re-implanted. It is done by re-infusing the blood through the vein.

The patient of multiple sclerosis after BMT is in a vulnerable position and is prone to infections until the harvested cells are taken up. Hence, the patient is given a course of antibiotics.

The immune system rebuilds itself and recovers to be capable to protect the individual. Until then the patient is advised to stay under hospital observation. This can range anywhere from six to eight months. The patient is discharged within 10 to 100 days.

What are the pros and cons of Bone Marrow Transplant for Multiple Sclerosis?

Since the procedure is still under experiment only for multiple sclerosis, it is not possible to analyze all the risks and advantages of BMT in multiple sclerosis. Some of the advantages are:

  • There are minimum chances of rejection of the transplant. Since the bone marrow harvest is a part of the patient (in the case of autogenous transplantation), there is no foreign body reaction.
  • Since the transplant is from the patient’s own bone marrow, it eliminates the need to use immunosuppressant medications.
  • It is life-changing for a patient who has multiple sclerosis, which is a degenerative defect that leads to a slow loss of function of many vital organs.

Some of the risks that are involved are:

  • During the initial days, the patient has the poorest immune system and thus, the natural defense mechanism is very low. This puts the patient at risk of infection at any given point, due to any given situation. Until the immune system is rebuilt and the transplant responds to the treatment, the patient is placed under intensive care and handled with utmost care and precaution. Even after discharge, the patient is advised to pay attention to the surroundings and avoid chances of infection
  • It would be a costly mode of treatment.
  • In very rare cases of multiple sclerosis, the transplant may not get accepted by the patient’s body, in which case the cause is analyzed and the transplant can be tried again.
  • Common side effects of chemotherapy are suffered by the patient which includes nausea, vomiting, and even hair loss in heavy doses. These subside once the course of a chemotherapy drug is over.

The treatment for multiple sclerosis has reached a point where one can now reboot the entire immune system to not produce antibodies against the body’s lymphocytes. One must do adequate research on the procedure, and the medical institute from where they choose to get the treatment done. Awareness about the condition and its pros and cons will ensure a better success rate for the treatment.