Studies say stem cell treatment for multiple sclerosis is not yet ready for prime time

DEAR DR. ROACH >> My 45-year-old daughter was diagnosed with multiple sclerosis about a year ago following alarming bladder problems and numbness. She received steroids that effectively treated the bladder problem. She subsequently had a relapse with more widespread numbness and a feeling of being off balance. Within a short time, she started on Ocrevus. She continues to have symptoms.

She is considering going out of the country for stem cell treatment. Her neurologist does not support this step. He would like her to wait until the research data supports the treatment and/or new and better treatments become available. My daughter is considering the stem cell treatment because she believes it gives her the best chance of impeding the progression of the disease. Where do you stand regarding stem cell treatment for MS? DEAR READER >> Stem cells are cells that have the ability to differentiate into many different types of cells, under the right conditions. Multiple sclerosis is thought to be an autoimmune disease directed at the myelin, the protective layer around nerve cells that make up much of the white matter of the brain. Cells that have been used for treatment of MS include the patient’s own stem cells (usually obtained from the patient’s blood after giving medication to release it from the bone marrow) or umbilical cord blood. There are some results of studies about these therapies.

One type of study collected stem cells from the patient, then used chemotherapy to largely but not completely destroy the person’s existing immune system, then replaced the immune cells in the bone marrow with the person’s own stem cells. Participants in the study showed improvement in their rates of relapses, but also improvements in the activity of MS as seen by MRI scan.

Umbilical cord blood also has been used without the chemotherapy that damages the person’s immune system. A study of 20 subjects was published in 2018 showing improvements in symptoms and an apparent slowing of disease seen by MRI.

Neither of these types of treatments have been subjected to the most rigorous type of trial, a controlled study.

Contact Dr. Roach at ToYourGoodHealth@med. cornell.edu.