New MS Treatments: Guarded Good News
April 16, 2002 -- Aggressive new treatments for multiple sclerosis offer new hope for patients failing standard therapy.
One study shows that a risky treatment can help MS patients whose disease keeps getting worse and worse. Another shows that a combination of two MS drugs can help when one drug doesn't work by itself. The findings come from very early clinical studies reported at this week's annual meeting of the American Academy of Neurology.
The most dramatic and most controversial report is from George H. Kraft, MD, director of the MS Clinical Center at the University of Washington in Seattle. Kraft's team is working on new ways to perform the most radical treatment for MS. It calls for total destruction of a person's immune system. Stem cells culled from the patient's blood are then used to restore normal immune function.
"This appears to be the most powerful tool we have against this terrible disease," Kraft tells WebMD. "The 26 patients in this study all had failed standard treatments. All were deteriorating very rapidly. We expect they would have continued to deteriorate at same rate." The patients in the study had either an aggressive relapsing-remitting form or the secondary progressive form of the disease.
Nobody is sure what causes MS, a disease where the insulation surrounding nerves deteriorates, making the nerves unable to conduct electrical signals appropriately. One theory is that the body's immune system somehow starts to attack the tissue that lines nerve cells. If this is the case, then replacing the immune system might stop MS. It's a big gamble. MS is an awful disease -- sometimes leaving people completely paralyzed -- but it's rarely fatal. Yet this kind of treatment can kill. In earlier studies, similar treatments killed as many as one in 10 patients -- a higher death rate than usually seen in cancer patients treated the same way.
The treatment calls for high-dose, whole-body irradiation followed by chemotherapy to wipe out the bone marrow (where immune system cells as well as other cells develop). This is followed by injections of antibodies that kill off any remaining immune cells in the blood. Before treatment begins, the patient receives an immune-boosting injection that fills the blood with stem cells. These cells are harvested from the patient's blood and given back to the patient to restore the immune system.
One patient in the Kraft study died after receiving antibodies in rabbit serum. All other patients received antibodies in horse serum. Two other patients had illnesses related to the treatment.
Six months after having their immune systems restored with the stem cell transplant, none of the surviving 25 patients are taking MS drugs. Most of the patients are stable; six are somewhat better. Five patients got worse, although their rate of decline seemed much slower than before.