Multiple sclerosis (MS) is a chronic, inflammatory, autoimmune disease of the central nervous system that often presents in persons between their second and fourth decade of life. The primary pathophysiologic feature of MS is demyelination and axonal destruction, leading to incomplete and poor nerve conduction. Symptoms of MS often depend on the severity, extension, and location of areas of inflammation and the course of the disease. Because of the timing of onset and the disease burden on patients, MS can greatly affect patients financially.
Before 1993, the treatment of MS had limited options for reducing relapses. Therapy primarily consisted of treating acute exacerbations with corticosteroids, and no treatments altered the course of the illness. Interferon and glatiramer acetate, which were both released in the mid 1990s, offered new treatment options to decrease disease activity which were not previously available. Many new drug therapies were launched afterwards. Since this time new oral agents, and new biologies have come to the front in treating MS.
Autologous hematopoietic stem cell transplantation (AHSCT) has been a used as treatment for MS for over two decades. The treatment was used initially in patients with advanced progressive disease as a rescue therapy to try and halt disease progression. Limited efficacy was seen in this group of patients. More recently its use in patients with active relapsing-remitting MS has been associated with prolonged clinical and magnetic resonance responses, and, in some cases, an improvement in disability to a degree rarely seen with other treatments. But because of AHCT toxicity its future place among others therapies is needed to discuss.