Abstract
Autologous haematopoietic stem cell transplantation (AHSCT) is increasingly used to treat people with multiple sclerosis (MS). Supported by an evolving evidence base, AHSCT can suppress active inflammation in the central nervous system and induce long-term changes in immune cell populations, thereby stabilizing, and, in some cases, reversing disability in carefully selected MS patients. However, AHSCT is an intensive chemotherapy-based procedure associated with intrinsic risks, including profound cytopenia, infection, and organ toxicity, accompanied by an on-going degree of immuno-compromise and general deconditioning, which can be associated with a transient increase in functional impairment in the early stages after transplantation. Although international guidelines and recommendations have been published for clinical and technical aspects of AHSCT in MS, there has been no detailed appraisal of the rehabilitation needed following treatment nor any specific guidelines as to how this is best delivered by hospital and community-based therapists and wider multidisciplinary teams in order to maximize functional recovery and quality of life. These expert consensus guidelines aim to address this unmet need by summarizing the evidence-base for AHSCT in MS and providing recommendations for current rehabilitation practice along with identifying areas for future research and development.
Highlights
Multiple SclerosisMultiple Sclerosis (MS) is an acquired chronic immune-mediated inflammatory disease of the central nervous system (CNS) and is the commonest cause of non-traumatic disability in adults of working age [1, 2].Approximately 85% of people with Multiple SclerosisMultiple Sclerosis (MS) present with a relapsing remitting course (RRMS) characterized by distinct episodes of new or worsening neurological dysfunction followed by complete or partial recovery [3]
Similar to the medical management for MS, rehabilitation intervention is determined by the symptoms and clinical presentation for each patient and a full clinical assessment is essential with the rehabilitation being goal directed and person centered [24, 25]
Following approval by the processes of the EBMT Autoimmune Diseases Working Party (ADWP), an authorship group was convened from clinicians from relevant professional groups active in or associated with the ADWP and Nurses Group (NG) of the European Society for Blood and Marrow Transplantation (EBMT) with experience in Autologous Haematopoietic Stem Cell Transplantation (AHSCT) for neurological ADs as well as patient consumer representation via the EBMT Patient Advocacy Committee
Summary
Multiple Sclerosis (MS) is an acquired chronic immune-mediated inflammatory disease of the central nervous system (CNS) and is the commonest cause of non-traumatic disability in adults of working age [1, 2]. In recent years an increasing evidence base and published professional guidelines have supported more widespread use of AHSCT as a treatment option in patients with highly active RRMS. Similar to the medical management for MS, rehabilitation intervention is determined by the symptoms and clinical presentation for each patient and a full clinical assessment is essential with the rehabilitation being goal directed and person centered [24, 25] This should be multi-disciplinary with involvement from neurologists, specialist nurses, rehabilitation specialists, physiotherapists, occupational therapists, speech and language therapists, and neuro-psychologists. The following guidelines and recommendations have been established by consensus to support therapists with the rehabilitation of patients with MS undergoing AHSCT with the goal of optimizing management and overall outcome
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