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Multiple sclerosis

Multiple sclerosis (MS) is the most common chronic inflammatory demyelinating disease of the central nervous system (CNS) and the leading cause of non-traumatic neurological disability of young adults.

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It affects ~2.3 million people worldwide with a prevalence of 1 in 700 adults. Following diagnosis, patients rapidly fall out of employment.

 

Recent data shows that after 5 years only 25% of people are still working.

 

As a result, MS has an economic impact disproportionate to its prevalence related to the high cost of disease-modifying therapies (DMTs), the direct and indirect costs of relapses and associated costs of benefits and personal care.

 

MS is a rare disease in children, but its consequences are particularly severe, as disability may be life-long.

Until recently, the most effective treatment for MS was considered to be DMTs, developed mainly by the Israeli company TEVA. But if immunomodulation with DMTs stopped working, the patient was defenseless against the disease progression and imminent disability. However, the latest therapy, approved in the U.S. and Europe, offers an excellent chance for productive, full-quality life.

 

In 2019, after years of international clinical trials, the American and European Group for Blood and Marrow Transplantation recommended autologous hematopoietic stem cell transplantation (aHSCT) for MS, and provided clear guidelines for patient selection, transplant technique, follow-up and future development.

 

There is no cure for multiple sclerosis. The aim of any therapy is to achieve stable remission, a state of No Evidence of Disease Activity (NEDA), reflected by absence of clinical relapses, disability progression and MRI disease activity. It has been statistically proven that currently approved DMTs (Alemtuzumab, Natalizumab, Ocrelizumab, etc.) can achieve NEDA in about 65% of cases for up to 3-5 years.

Compared to the drug therapy, the efficacy of aHSCT is about 30% higher with NEDA rates up to 93% in 5-7 years. In patients under 18 years, who usually respond to drug therapy with toxic reactions, the aHSCT was well tolerated and associated with improvements of disability-free rates in 81% of patients with progression free survival (PFS) of 100% for at least 5 years.

 

The aHSCT for MS in Israel is carried out by neurologists and hematologists at the largest public hospital of the country.

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Usually, the process starts with telemedicine consultation with leading MS neurologist. He analyzes the patient’s documents in video-conference and evaluates the indications for autologous stem cell transplantation. After that, the patient is invited to Israel.

 

Preparation for the autologous hematopoietic stem cell transplantation takes about 1 business week and is usually carried out on an outpatient basis.

 

Preparation includes:

  • Comprehensive blood tests

  • Functional respiratory tests (evaluation of pulmonary function)

  • Echocardiography

  • PICC line catheter insertion

  • Consultation with hematologist

  • Consultation with neurologist from the Multiple Sclerosis Center

 

If necessary and recommended by the specialists, the evaluation may include MRI of brain or/and spinal cord with Gadolinium, consultation with neuro-ophthalmologist, specific laboratory tests, etc.

 

The next step is stem cell collection. Sometimes special medications are used to stimulate the process.

 

Afterwards, the patient is treated with chemotherapy and immunosuppressive drugs in a hospital setting. After achieving an acceptable result of immune suppression, transplantation of “prepared” own stem cells is carried out.

 

Inpatient hospitalization for preparation, transplantation and recovery after the procedure takes, on average, up to one month.

 

After discharge, it is necessary to stay in the country for a few more weeks for outpatient monitoring by medical specialists.

 

Before leaving Israel, treating MS neurologist and hematologist will consult you, performing initial assessment of the procedure effectiveness and elaboration of further course of action.

 

Throughout the program, Manor Medical Center staff and medical personnel provide comprehensive medical and logistical support to the patient.

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Manoc Medical Center
26 Ha'Barzel St.
Tel Aviv 69710 Israel

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