First Steps: Confessions of an HSCT Survivor
Confessions? Survivor? Oh puh-leeze. So melodramatic, Dave. I know, right? But when I was preparing to get an autologous hematopoietic stem cell transplant (HSCT) in 2010 for my aggressive multiple sclerosis, I really could have used an insider's look as to what I was getting myself into. I was part of the HALT-MS clinical trial sponsored in part by the National Institutes of Health, and I'll say straight away that it saved my life. But it was so new that I had few resources and experiences to lean on. Here are just a few lessons learned, and some personal confessions, after going through a stem cell transplant — complete with high-dose chemotherapy and a lengthy hospital stay — for my ornery MS. Part one of this series is about the first steps to consider before undergoing HSCT.
Researching HSCT is, well, complicated
Before you pursue this path of treatment for your multiple sclerosis, a little research is in order. Okay, a lot of research. Today you can find fan sites galore with all sorts of advice on HSCT. And like most fan sites, they are predictably rah-rah with little balance for the "maybe-don't-do-that" side. The information can be helpful, but take it with a grain of NaCl, as people don't tend to boast about failed treatments. I recommend reviewing past research (I've posted all HSCT abstracts from the past 15 years on the forum at ActiveMSers) and sticking to reputable, unbiased websites. One last thing: HSCT is not "stem cell therapy," which typically does not use chemo or involve a hospital stay and has little research to back up its effectiveness.
Your neurologist will not be overjoyed
So your interest is piqued. Even in 2018, HSCT still has many detractors, and when you tell your neuro that you are thinking — just thinking — of getting a transplant, he or she will become the WORLD'S DUMBEST, LEAST PROGRESSIVE, MOST CONSERVATIVE NEURO EVER. While that may technically be true, in all likelihood your doc just cares for you. And unless it is part of a clinical trial, getting HSCT probably will mean going abroad and spending out-of-pocket anywhere between $50,000 and $200,000 for a transplant at a facility that may not be terribly experienced with the treatment, a not-insignificant safety risk. Fortunately for all of us with MS, there are powerfully effective treatments today, in particular Ocrevus and Lemtrada, two big guns that were not available to me at the time. Had they been, they may have influenced my decision on whether to pursue a transplant.
Your health insurance company will deny your claim
Even though I had multiple relapses and dropped 3 EDSS points in a span of months, going from using the rare cane to a walker, my insurance company said no. Even after I produced dozens and dozens of positive studies, many in prestigious journals, they said no. Even after I had exhausted all available FDA-approved treatments for MS (Tysabri included) and was vying to participate in a trial backed by the US government, they said no. Until Phase 3 HSCT trials show widespread, unassailable success, insurance companies are going to say no virtually every time (with the possible exception of clinical trials). Don't take it too personally. Or do, and fight them for five years and get your money back with interest along with an article in the New York Times.
The risks are plentiful. And you likely won't care
If you are dead-set on getting a transplant, the use of the term "dead-set" is a realistic conclusion. But you will mostly ignore it. Your brain will rationalize that serious complications happen to other people. You will also scour the internet for stats that show it is safer than mowing your lawn or texting while crossing the street or some such thing. While HSCT has gotten safer over the years (the consent form I signed listed the risk of death at an admittingly frightening 1 in 20), it is still the riskiest MS treatment. By far. Bottom line: even today you have better odds of dying from HSCT complications than you do of winning $7 in the Powerball. There are other significant risks too, from likely infertility to permanent hearing loss (due to life-saving antibiotics) to potential blood cancers years later. It goes without saying, make sure your will and advanced healthcare directive are up to date.
Going into HSCT with realistic expectations is challenging
I'm an optimist. You don't get HSCT if you think it isn't going to work. But try to dial back the idea that this is the Holy Grail of MS research that will rid your body forever of this nastiness. Gone, like in Alien when that bugger popped out of that dude's chest and scampered away. Holy Jesus. Sure, the alien left his body, but it didn't end well. Know that after HSCT most people will not experience a dramatic reversal in disability, and the odds of the transplant holding off your MS for 5 or more years is considerably higher for the ideal candidate (one who is young, recently diagnosed with aggressive MS, with therapy failures) than for those with progressive MS who have had the disease for years. Tell yourself pausing progression — not being cured — is the goal, and any gains are gravy.
This is still just the beginning
So that's just a beginning taste of my HSCT adventure. Indeed, I could write a book on my experience with this topic, which conveniently I am currently in the process of doing. But that will take many moons. For the time being, MultipleSclerosis.net readers can look for more HSCT stories from me right here (along with many other less-stressful tales). If you have topics/questions/concerns you'd like me to address in future HSCT articles, please post them below with your comments. Until next time, be active, stay fit, and keep exploring!
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