Nicoletta: Dr Rog, I’m going to be asking you some questions about haematopoietic autologous stem cell transplants, and obviously that’s a bit of a mouthful, so if you don’t mind, I’m going to refer to it as HSCT. So first of all, is it safe, is HSCT safe?
Dr David Rog, Consultant Neurologist: I’m glad that you, I’m glad that you went through it and you defined it. So autologous means that the patient’s own stem cells are taken out and that the patient’s bone marrow is then destroyed or oblated, and then the stem cells are then infused back into the patient. And so the patient’s getting their own cells back. And I think one of the key aspects about stem cell transplants is obviously to try and understand where the source of the stem cells are from. That then has an effect in terms of safety outcomes, for example, so safety is a relative term and it means different things to different people. The outcomes of stem cell transplantation, which is a significant procedure and obviously does carry risks, particularly early on when the patient’s recovering from the procedure itself, so all deaths, for example, from stem cell transplants within a hundred days post-transplantation are usually considered to be transplant related.
And what has been shown over time are two things: the first is that the outcomes for autologous stem cell transplants, in other words, where patients receive their own cells back, are better in terms of mortality, in other words, the risk of dying as a result of the procedure, than for non-autologous stem cell transplants where the cells are received from a donor. And the second thing is that in the accredited centres, in the centres that really are doing lots of stem cell transplantations, usually for other conditions, but increasingly now in some centres for MS as part of clinical trials or otherwise, that the mortality rates are dropping. So we would ordinarily quote our patients a risk of around five per cent mortality.
In other words, a five per cent risk of dying as a result of an autologous stem cell transplant, receiving their own cells back. However, if you look at some of the recent clinical trials and also some of the retrospective analyses, the figure of five per cent is actually going lower and I know that our local unit, for example, would quote a lower risk than that. So I think safety is a relative term and I think it is that the autologous transplant is becoming safer, but as one of the editorials said recently in one of the medical journals, it’s still a riskier procedure than any of our disease modifying treatments that are available in MS so it shouldn’t be undertaken lightly.
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Dr David Rog is a consultant neurologist at the Salford Royal NHS Trust. He gained his MD in liverpool and he completed his neurological training between 2002 and 2006 on the North West rotation at Lancashire Teaching Hospitals Trust and Greater Manchester Neuroscience Centre. Dr Rog is the Chairman of the Clinical Research Steering Group at Salford Royal and the Nervous System Theme lead for Greater Manchester Comprehensive Local Research Network.