Treatment day 11: Final dose of chemo. YEAH!!! & A simple description of how HSCT works against MS

Today marked another milestone. Final does of chemo has been infused into my body. Now it just needs to continue its job for me and my doctors. In a couple of days the dirty deed of knocking my immune system for a loop should be done and my body ready for the stem cell transplant. It seems to be that the clouds are parting and I can see a world in front of me that is MS free. It's just waiting for me and I am anxious to make that trek and let the beautiful light shine on my face. :-)

I decided to add this simple description of how this treatment works for MS patients like myself. Many of you have been reading the blog for awhile now and I believe this will help to give you a pretty good handle on what is going on, when, and why.

 SIMPLE DESCRIPTION OF HOW HSCT WORKS

This treatment is designed to reset your immune system and halt the progression and activity of multiple sclerosis. A very simple description has been attached by many to describe how HSCT works.  It has been described as a “re-boot” and in many respects this simplistic explanation is perhaps the easiest way to understand how the procedure works. In the same way that you re-boot your computer when it is playing up, HSCT re- boots your immune system and restarts it so that the malfunction is repaired and it works properly again.  Your new immune system has  no cell  memory of malfunction and no longer attacks your nerves (myelin) so that your body has a chance to repair the damage previously inflicted! No more MS!

HOW HSCT  CURES MULTIPLE SCLEROSIS

HSCT affects a cure for MS by either completely (myleoablative) or partially (non myleoblative) wiping out the memory of the bodies immune system. This is achieved by effecting a change of the body’s overall T and B-lymphocyte  (antigen binding) collection thus making autoimmunity inactive and consequently causing the body’s immune cells to become “antigen naive”. This results in restoring immune self-tolerance. Ultimately this stops the underlying MS disease activity & progression and is where the “resetting” the immune system phrase is coined. After HSCT is performed the body then has a chance to repair or reconfigure adaption to existing neural damage without the hindrance of ongoing disease activity and progression, often resulting in improvement of existing conditions and ongoing recovery of lost function.

Chemotherapy is used to destroy the T- and B-lymphocytes of the body which carry the faulty memory so that virgin cells which  are unprogrammed,  may replace them. These  are generated by the bone marrow.   Successful HSCT is entirely  dependent on the chemotherapy aspect of the treatment, which is why simply injecting stem cells into the body does not render the body’s immune system self-tolerant. It is imperative that the chemotherapy destroy the bad cells before the newly harvested virgin cells that have been produced in the bone marrow be reintroduced to the body to get the new immune system firing on all pistons!

STIMULATING PRODUCTION OF STEM CELLS.

Injections are given twice a day for approximately 4 days in order to stimulate production of stem cells. This process, which causes extra stem cells to be produced, is known as mobilization.   This is a very straightforward process and mild bone pain if experienced can be alleviated with over-the-counter painkillers.

COLLECTION OF STEM CELLS

Collection of stem cells is a process called “Apheresis”. Some pain in the hip has been reported but in most cases it is a pain free procedure.  Blood is withdrawn through a catheter and circulated through a cell-separating machine, which separates and collects white blood cells, including the stem cells. The remaining blood cells are returned to the body at the same rate that they were removed.   After collection the cells are frozen and stored under special conditions until they are needed for transplant (reintroduction to the body).

ADMINISTERING CHEMOTHERAPY

Administration of chemotherapy takes four days. This will wipe out the existing immune system.  Analysis of the blood will be used to evaluate when the system is adequately prepared in terms of “wipe out” for the stem cell transplantation.  Once it has been determined that this has taken place and the body is effectively devoid of its previously malfunctioning immune system, isolation will begin and only attending medical staff will be allowed access to minimize any possibility of germs entering the sterile environment while the immune system is effectively non existent.

PERFORMING THE STEM CELL TRANSPLANT

Once chemotherapy is completed the previously harvested stem cells are returned to the body.  It is similar to a blood transfusion. People have commented on symptoms that include nausea, diarrhea, cough fever, chilling and often a headache. Medication is provided to decrease these effects. It is worth remembering the associated discomfort is short lived and the trade off at the end of the day is incomparable in terms of what it offers! The frozen stem cells are thawed in warm water quite simply and infused back into the body.

 

THE ENGRAFTMENT PART OF THE PROCEDURE

Engraftment is the word given to the process when the harvested stem cells that have been reintroduced to the body begin to grow (engraft). This usually takes between one and three weeks and confirms that the new immune system is now producing blood cells as expected. Aching in the bones, lower back thighs and pelvis has been reported during this phase, but the new immune system will be totally devoid of memory of any MS! Once the new system is back to operating normally the blood count will rise and the white cells in the blood will begin to resume their job, which is to fight off bacteria and prevent infections. Shortly after this happens the hospital releases the patient, but it must be remembered that the immune system will remain compromised for some time. Caution must be observed in terms of exposure to any sort of illness for the next year at least.

THE RECOVERY PHASE

The complete recovery phase is acknowledged as taking twelve to eighteen months. Interestingly in the same way no two people have exactly the same symptoms from MS, recovery works in a similar way. Some people have reported seeing continued improvement long after the procedure. They claim that improvements have taken place as long as 5 years post transplantation. Depending on the type of MS diagnosed prior to  receiving treatment, results can vary considerably. Please see “what to expect” in the menu under ‘About HSCT’. What has been acknowledged more recently is that excluding the small percentage of people that are considered “failed” (approx. 15% – 25%) HSCT has been shown to halt disease progression of MS in all types of the disease. The best  part of getting HSCT  is finding out  that the procedure has been successful and underlying disease activity has indeed been halted. The icing on the cake is experiencing improvement and often reversal of pre-existing symptoms, some or in the case of the lucky ones – many!