Multiple Sclerosis: Treatments, HSCT and Stem Cell Therapy Explained

What is multiple sclerosis?

Multiple sclerosis (MS) is a chronic disease of the brain and spinal cord. The immune system attacks myelin, the protective coating around nerve fibres, causing inflammation, scarring (sclerosis) and nerve damage. It is a leading cause of neurological disability in young adults. The NHS MS guide explains the basics.

Types of MS

• Relapsing-remitting MS (RRMS): episodes of new or worsening symptoms followed by recovery. Most people start here.
• Secondary progressive MS (SPMS): gradual worsening after a relapsing phase.
• Primary progressive MS (PPMS): steady progression from the start.

Symptoms

• Vision problems, such as blurred vision or painful eye movement (optic neuritis)
• Numbness, tingling or electric shock sensations
• Muscle weakness, stiffness and spasms
• Balance and walking difficulties
• Fatigue, often severe
• Bladder and bowel problems
• Thinking, memory and mood changes

Causes

The cause is not fully understood. Contributing factors include genetics, low vitamin D, smoking, obesity in adolescence and Epstein–Barr virus infection, which large studies have strongly linked to MS risk.

Diagnosis

A neurologist diagnoses MS using the McDonald criteria, which look for evidence of damage in different areas of the central nervous system over time.

Test	What it shows
Brain and spinal cord MRI	Lesions (plaques), new or enhancing lesions show active inflammation
Lumbar puncture	Oligoclonal bands in spinal fluid
Evoked potentials	Slowed nerve signals
Blood tests	Rule out conditions that mimic MS
EDSS score	Rates disability level (0 to 10)

Your MRI reports and EDSS score are central to any treatment decision. You can send your MRI and neurologist letters for a doctor review to get an honest opinion on what may or may not help.

Standard treatment first

Disease-modifying therapies (DMTs) reduce relapses and slow disability, and are the most important treatment for MS. Options include:

1. Injectables and oral drugs: interferons, glatiramer acetate, teriflunomide, dimethyl fumarate, S1P modulators (fingolimod, siponimod, ozanimod, ponesimod), cladribine.
2. High-efficacy monoclonal antibodies: natalizumab, ocrelizumab, ofatumumab, ublituximab, alemtuzumab.
3. Ocrelizumab is approved for some people with primary progressive MS.
4. Relapse treatment: short courses of high-dose steroids.
5. Symptom management: physiotherapy, spasticity medicines, bladder care, fatigue management, mental health support.

Starting a DMT early, under a neurologist, offers the best long-term outcomes.

Stem cell treatments for MS: two very different things

	Autologous HSCT	Mesenchymal stem cells (MSCs)
What it is	Chemotherapy to reset the immune system, then reinfusion of your own blood stem cells	Infusion of stromal cells, often from umbilical cord or fat tissue
Setting	Specialist transplant hospital, several weeks	Outpatient or short stay
Best evidence	Randomised MIST trial (Burt et al., JAMA, 2019) in relapsing MS	Phase 2 MESEMS trial (Uccelli et al., Lancet Neurology, 2021): no significant effect on new lesions
Who benefits most	Young people with highly active relapsing MS despite DMTs	Not established
Key risks	Infection, infertility, secondary autoimmunity, treatment-related death (small but real)	Infusion reactions, infection, unknown long-term effects
Regulatory status	Offered at selected centres in the UK, Europe and elsewhere; under trial (e.g. BEAT-MS in the US, StarMS in the UK)	Not approved for MS in the US, UK or Australia

Autologous HSCT

aHSCT is the stem cell approach with the strongest evidence. It is offered for highly active relapsing MS at some specialist centres, including in the UK, and is being compared with best available drugs in ongoing trials. It is a serious treatment, carried out by transplant haematologists working with neurologists. It is not part of our outpatient programs. If you may be a candidate, ask your neurologist about referral.

Mesenchymal stem cells

MSCs can modulate immune activity in the lab, which is why stem cell therapy has been tested in MS. Phase 1 and 2 studies suggest MSC infusions are generally well tolerated, but the largest controlled study (MESEMS) did not show a significant reduction in new MRI lesions. Some patients report changes in fatigue or wellbeing, but such reports are hard to interpret without controls. Overall, MSC therapy for MS is experimental.

Patients from the UK, Australia and the US should know that no regulator in those countries has approved MSC therapy for MS. In the US, the FDA has not approved MSC therapy for MS and warns about unapproved stem cell therapies. Supportive treatments such as NAD+ IV therapy are wellness interventions without good evidence in MS.

Who may be a candidate, and who should not

May be considered for an MSC-based program (after doctor review):

• Confirmed MS, under the care of a neurologist
• Stable on DMTs or with a neurologist aware of the plan
• Realistic expectations: experimental, no guaranteed benefit
• Recent MRI and blood tests

Should not, or should look elsewhere:

• Highly active relapsing MS that is not controlled: talk to your neurologist about switching DMTs or HSCT referral
• A relapse within the last few weeks
• Active infection, including JC virus–related concerns on natalizumab
• Pregnancy
• Active cancer
• Anyone planning to stop DMTs

Risks

• Infusion reactions: fever, headache, fatigue
• Infection
• Rare blood clots
• Heat and travel stress can temporarily worsen MS symptoms (Uhthoff’s phenomenon), relevant in Bangkok’s climate
• Unknown long-term effects

Cells are prepared in ISO 9001:2015-certified partner laboratories.

What a Bangkok program looks like

1. Send your records. MRI reports, EDSS, neurologist letters and medication list.
2. Doctor review. An honest assessment; we may advise HSCT referral or a trial instead.
3. Assessment on arrival. Neurological examination and safety blood tests.
4. Treatment plan if appropriate, alongside your existing DMT.
5. Records for your neurologist.

See how it works. Related guides: Parkinson’s disease and spinal cord injury.

Aftercare

• Continue your DMT and all medicines
• Stay cool: air-conditioned rest, hydration, avoid midday heat
• Rest for a few days after infusion
• Report new neurological symptoms immediately
• Continue physiotherapy and follow-up MRI with your neurologist

Sources

• NHS: Multiple sclerosis
• Burt RK, et al. Effect of nonmyeloablative HSCT vs continued disease-modifying therapy on disease progression in relapsing-remitting MS (MIST). JAMA, 2019.
• Uccelli A, et al. Safety, tolerability, and activity of mesenchymal stem cells versus placebo in multiple sclerosis (MESEMS). Lancet Neurology, 2021.
• U.S. FDA: Consumer Alert on Regenerative Medicine Products Including Stem Cells and Exosomes
• ClinicalTrials.gov