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Review
. 2020 Dec 11:11:556141.
doi: 10.3389/fneur.2020.556141. eCollection 2020.

Rehabilitation Before and After Autologous Haematopoietic Stem Cell Transplantation (AHSCT) for Patients With Multiple Sclerosis (MS): Consensus Guidelines and Recommendations for Best Clinical Practice on Behalf of the Autoimmune Diseases Working Party, Nurses Group, and Patient Advocacy Committee of the European Society for Blood and Marrow Transplantation (EBMT)

Fiona Roberts  1 , Helen Hobbs  1 , Helen Jessop  2 , Cristina Bozzolini  3 , Joachim Burman  4 , Raffaella Greco  5 , Azza Ismail  2 , Majid Kazmi  6 , Kirill Kirgizov  7 , Gianluigi Mancardi  8 , Susan Mawson  9 , Paolo A Muraro  10 , Mathieu Puyade  11   12 , Riccardo Saccardi  3 , Barbara Withers  13 , Bregje Verhoeven  14 , Basil Sharrack  2   9 , John A Snowden  2
Affiliations
Review

Rehabilitation Before and After Autologous Haematopoietic Stem Cell Transplantation (AHSCT) for Patients With Multiple Sclerosis (MS): Consensus Guidelines and Recommendations for Best Clinical Practice on Behalf of the Autoimmune Diseases Working Party, Nurses Group, and Patient Advocacy Committee of the European Society for Blood and Marrow Transplantation (EBMT)

Fiona Roberts et al. Front Neurol. .

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.

Keywords: autoimmune diseases; autologous haematopoietic stem cell transplantation; exercise; multiple sclerosis; neurological diseases; physical therapy; rehabilitation.

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Conflict of interest statement

FR and HH work for Hobbs Rehabilitation, JS declares honoraria for speaking at educational meetings from Sanofi, Jazz, Janssen, Gilead, and Mallinckrodt, BV declares honoraria for speaking at educational meetings and consultancy from Janssen, Takeda, and Amgen. PM reports travel support and speaker honoraria from unrestricted educational activities organized by Novartis, Bayer HealthCare, Bayer Pharma, Biogen Idec, Merck-Serono, and Sanofi Aventis. He also discloses consulting to Magenta Therapeutics and Jasper Therapeutics. The remaining authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest. The reviewer EP declared a shared affiliation, with no collaboration, with two of the authors RS and CB to the handling Editor. The Handling Editor declared a past co-authorship with one of the authors GM.

Figures

Figure 1
Figure 1
Schematic overview of the AHSCT process Step one: Mobilization of AHSCs from the bone marrow by leukapheresis and cryopreserved until required. Step two: Conditioning regimen using high dose chemotherapy for ablation of the immune system. Step 3: Re-infusion of autologous haematopoeitic stem cells (AHSC). Engraftment of bone marrow takes 10–14 days. Step 4: Post-transplant care and supportive therapy.
Figure 2
Figure 2
Rehabilitation Pathway for MS patients undergoing AHSCT (AHSCT, Autologous Haematopoietic Stem cell Transplantation; OMs, Outcome Measures; Rehab, Rehabilitation).
See this image and copyright information in PMC

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