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Webinar record
Webinar record
October 11 (2026)
Multiple sclerosis is a chronic disease. People may live with it for many years, but their quality of life can decline over time, sometimes leading to irreversible disability. The progression may be slow or aggressive. Often it begins slowly and then accelerates.
The number of people with multiple sclerosis is increasing worldwide: approximately two million in 2013 and more than three million in 2024, according to the figures in my presentation. There are many disease-modifying therapies in neurology, with varying levels of effectiveness. However, in my view these approaches may delay MS but cannot eliminate the underlying autoimmune process. In MS, the immune system mistakenly attacks the protective myelin sheath around nerve fibers, disrupting nerve conduction. Both autoreactive T and B lymphocytes are involved; it is not simply a T-cell or B-cell disorder. Our institution is the Pirogov National Medical and Surgical Center, and I represent the Department of Hematology and Cellular Therapy.
This is a large government academic hospital under Russia's Ministry of Health, with clinical, educational and research departments. Our department was established more than 20 years ago. Over this period, we have treated almost 2,500 patients with different forms of MS, as well as people with other autoimmune diseases. We have extensive single-center experience in this field. Autologous hematopoietic stem cell transplantation, or AHSCT, has more than 20 years of international experience. It is an intensive, short-course treatment intended to remove the dysfunctional immune system and allow a healthier immune system to rebuild from the patient's own hematopoietic stem cells.
The process includes stem cell mobilization and collection, high-dose immunosuppressive conditioning, stem cell reinfusion, and hematological and immunological recovery. Our current conditioning protocol combines fludarabine and cyclophosphamide. We believe it provides a favorable balance between effectiveness and toxicity. Information about transplantation for MS has appeared in international research publications and neurology textbooks, including a United States textbook published in 2025. In that context, the approach is discussed as potentially curative. Looking at our long-term follow-up, we have seen durable remissions in many patients.
In our experience, the reported success rates have exceeded approximately 70–75% for secondary and primary progressive MS and 85–90% for relapsing-remitting MS. Patients' quality of life can also improve during early and later post-transplant follow-up. We analyzed many variables, including chemotherapy regimens, antibodies, MRI activity and prior treatment, to identify who benefits most. Early transplantation, before substantial disability develops, is associated with better results. Relapsing-remitting disease, younger age and limited prior treatment are other favorable factors. Patients with extensive prior treatment or advanced disability may still improve, but their outcomes tend to be less favorable.
Our model has two equally important components: treating the disease and treating the patient. Disease-directed therapy focuses on immune depletion; we are also studying immune regulation and, for the more distant future, regenerative approaches. Patient-centered care includes rehabilitation, lifestyle measures, psychological support, relapse risk assessment and prevention, and symptomatic treatment. We should not concentrate only on the immune disease while overlooking the patient's daily functioning and quality of life. Finally, I'd like to mention an upcoming event: the N20 neuroscience meeting in Miami on December 13, connected with the G20. The event is expected to bring together international specialists, healthcare representatives and investment leaders.
I have been invited to represent our center and share our experience with multiple sclerosis and autologous transplantation. That concludes my short presentation. Thank you for your attention. I'm ready to answer your questions.
The number of people with multiple sclerosis is increasing worldwide: approximately two million in 2013 and more than three million in 2024, according to the figures in my presentation. There are many disease-modifying therapies in neurology, with varying levels of effectiveness. However, in my view these approaches may delay MS but cannot eliminate the underlying autoimmune process. In MS, the immune system mistakenly attacks the protective myelin sheath around nerve fibers, disrupting nerve conduction. Both autoreactive T and B lymphocytes are involved; it is not simply a T-cell or B-cell disorder. Our institution is the Pirogov National Medical and Surgical Center, and I represent the Department of Hematology and Cellular Therapy.
This is a large government academic hospital under Russia's Ministry of Health, with clinical, educational and research departments. Our department was established more than 20 years ago. Over this period, we have treated almost 2,500 patients with different forms of MS, as well as people with other autoimmune diseases. We have extensive single-center experience in this field. Autologous hematopoietic stem cell transplantation, or AHSCT, has more than 20 years of international experience. It is an intensive, short-course treatment intended to remove the dysfunctional immune system and allow a healthier immune system to rebuild from the patient's own hematopoietic stem cells.
The process includes stem cell mobilization and collection, high-dose immunosuppressive conditioning, stem cell reinfusion, and hematological and immunological recovery. Our current conditioning protocol combines fludarabine and cyclophosphamide. We believe it provides a favorable balance between effectiveness and toxicity. Information about transplantation for MS has appeared in international research publications and neurology textbooks, including a United States textbook published in 2025. In that context, the approach is discussed as potentially curative. Looking at our long-term follow-up, we have seen durable remissions in many patients.
In our experience, the reported success rates have exceeded approximately 70–75% for secondary and primary progressive MS and 85–90% for relapsing-remitting MS. Patients' quality of life can also improve during early and later post-transplant follow-up. We analyzed many variables, including chemotherapy regimens, antibodies, MRI activity and prior treatment, to identify who benefits most. Early transplantation, before substantial disability develops, is associated with better results. Relapsing-remitting disease, younger age and limited prior treatment are other favorable factors. Patients with extensive prior treatment or advanced disability may still improve, but their outcomes tend to be less favorable.
Our model has two equally important components: treating the disease and treating the patient. Disease-directed therapy focuses on immune depletion; we are also studying immune regulation and, for the more distant future, regenerative approaches. Patient-centered care includes rehabilitation, lifestyle measures, psychological support, relapse risk assessment and prevention, and symptomatic treatment. We should not concentrate only on the immune disease while overlooking the patient's daily functioning and quality of life. Finally, I'd like to mention an upcoming event: the N20 neuroscience meeting in Miami on December 13, connected with the G20. The event is expected to bring together international specialists, healthcare representatives and investment leaders.
I have been invited to represent our center and share our experience with multiple sclerosis and autologous transplantation. That concludes my short presentation. Thank you for your attention. I'm ready to answer your questions.
PARTICIPANT. I'm speaking on behalf of my friend, who has multiple sclerosis. As far as we understand, he has relapsing-remitting MS, and we indicated an EDSS score of 7.5 in the questionnaire. He experiences urinary incontinence, difficulty regulating his body temperature and occasional pressure ulcers. How will the staff support him during his stay? Also, after chemotherapy, what precautions will he need when flying home to Croatia? Does he need to isolate, or may he travel with other passengers?
SPEAKER — DR. DENIS FEDORENKO. Those questions are important for many other people with advanced MS. Urinary incontinence is relatively common in advanced disease and can be associated with spinal cord damage. Our main objective in advanced MS is to stop further disease activity and improve quality of life. We cannot guarantee that incontinence will resolve, although some patients regain function they had a year or more earlier. Transplantation addresses the abnormal immune system; symptoms also require their own management. He should be assessed by a neuro-urologist, who can recommend medication and exercises or rehabilitation to improve bladder control. During transplantation, patients receive many infusions, and we use a urinary catheter during the relevant stage of treatment.
This allows our team to manage the problem. We also follow infection-prevention procedures. We will arrange appropriate support while he is in hospital and give detailed recommendations for rehabilitation and care at home. Regarding travel, we discharge patients when their immune counts have recovered to a level we consider safe for travel, although they may still be below normal. We recommend wearing a mask in crowded public places, including airports, for about three months and avoiding close contact with people who are ill. We do not recommend prolonged isolation from family and friends. Patients can normally take a commercial flight. If a respiratory or bacterial infection occurs, we assess and treat it as necessary.
Our recommendation is to take sensible precautions rather than to remain isolated.
PARTICIPANT. What supplements do you recommend after treatment? Vitamin D or anything else?
SPEAKER — DR. DENIS FEDORENKO. We recommend maintaining an adequate vitamin D level, generally in the range of 50–100 as quoted in our protocol, and taking a usual supplement dose rather than the high-dose Coimbra protocol. I commonly recommend 4,000–5,000 IU per day. Other supplements, such as multivitamins, B vitamins or magnesium, are optional. Symptomatic treatment should be tailored to each patient's problems; for urinary incontinence, medications such as solifenacin may be discussed with a neurologist or urologist. We do not routinely recommend antibiotics, antivirals or antifungals after discharge in uncomplicated cases.
PARTICIPANT. I was diagnosed at the end of July, after my first relapse in May this year. My EDSS score is 2, and I have not yet received disease-modifying therapy. Based on your presentation, I seem to be a good candidate for AHSCT. You described it as potentially curative. What are my chances of staying in remission for the rest of my life?
SPEAKER — DR. DENIS FEDORENKO. I understand your situation. Could you repeat which medication you're currently taking?
PARTICIPANT. Nothing. I'm treatment-naïve.
SPEAKER — DR. DENIS FEDORENKO. So you are treatment-naïve. As I said in the presentation, limited prior treatment is one of the factors associated with better results. Other favorable factors include early relapsing-remitting MS, an EDSS score below 4, a disease history of five years or less, and age under 40. Not every patient needs to meet all of these criteria. We classify patients into lower-, moderate- and higher-risk groups according to the number of unfavorable factors. In our low-risk group, which resembles your situation, the reported success rate is about 92–93%. We also consider our current transplantation protocol much safer than earlier approaches.
In our experience, common short-term effects include hair loss, tiredness during the first one to three months and some increased susceptibility to infections early in recovery. We have not observed a major increase in certain late complications with this regimen in our cohort. Transplantation is a one-time treatment lasting roughly one month; routine disease-modifying medication afterward is generally not part of our protocol. By contrast, disease-modifying therapies may need to be continued or changed over many years. We believe earlier intervention can offer a greater chance of preventing disability. We also treat people with progressive disease, but the success rates we report for more advanced cases are lower, at around 75%, than for early relapsing-remitting disease.
PARTICIPANT. Do you think it's possible for remission to last a lifetime? I know HSCT began about 30 years ago, so perhaps there isn't enough long-term data yet.
SPEAKER — DR. DENIS FEDORENKO. Okay. So, we have long-term followup. We have patients who received this treatment 15, 20 years ago and they still in remission not having a post-rplant treatment after transplantation. So, first transplantation in the world was performed in 1997. We performed first transplantation in Russia in 1999 and started our hospital in 2005 started our clinical trial and 10 years later on from 2010 we started to use this approach in routine clinical practice also this is legal and official treatment in Russia not governed by M Ministry of Health now but we Our government, our ministry, healthc care support this treatment and but of course we have some problems with big pharma with neurological society but this treatment is legal and we have more than 20 year of experience. It's long enough.
If you find new medication right now, we need to wait at least 5–10 years to understand how this medication can help us transplantation history. This is long history and this is history of course this is not the same approach like 20 years ago. We developed our protocol mainly from high toxicity to high safety saving treatment effectiveness. So this is why first results were a little bit worse than our new result but we have big group of patients with followup five and 10 years using our modern approaches and success rate is very high for from 75% for advanced progressive variance including primary progressive to 90 95% for early relapsing-remitting multiple sclerosis.
So this is if you compare with the most effective traditional treatment this is 0 20 25% for anti-B cells therapy and 90 95% for transplantation and nothing between.
PARTICIPANT. Does that 90–95% success rate also apply in the long term, over five to ten years?
SPEAKER — DR. DENIS FEDORENKO. Yes. These are event-free survival results. As shown in my presentation, we analyzed almost 1,000 patients over five years. We also have smaller groups with ten-year follow-up. We're talking about years, not months.
PARTICIPANT. Thank you, Doctor. One last question: what's the best way to prepare for transplantation and improve the chances of success? Should I exercise or follow a special diet before and after treatment?
SPEAKER — DR. DENIS FEDORENKO. First, if someone has a chronic infection, such as an untreated dental problem, it should be addressed before transplantation. It is also important to approach treatment with motivation and confidence. I encourage patients to have a positive mindset rather than focusing constantly on the possibility of failure. In addition, they should follow a healthy lifestyle. Research in neurology supports the benefits of a Mediterranean-style diet. We recommend vitamin D at a usual dose, approximately 4,000–5,000 IU per day, rather than exceptionally high doses, and regular exercise. Smoking is particularly relevant to MS. Research has linked smoking to more aggressive disease and poorer treatment outcomes.
We advise patients to reduce smoking and ideally stop completely, especially after transplantation. Having an occasional glass of wine is a separate issue; smoking is the greater concern we emphasize here. After transplantation, our protocol does not generally require continued disease-modifying treatment, but patients should maintain healthy habits: a positive mindset, balanced nutrition, physical activity and no smoking.
PARTICIPANT. I stopped smoking two months ago. I started when I was 14, and I'm 27 now.
SPEAKER — DR. DENIS FEDORENKO. If you've stopped, that's good. No problem.
ADMINISTRATOR — ANASTASIA. One of our former patients had transplantation in July this year. A few days ago she began experiencing a burning sensation in her right leg while resting, without any other new symptoms, and she is worried. Her next MRI is scheduled for January. Would you recommend moving it forward, and what should she do now?
SPEAKER — DR. DENIS FEDORENKO. During the early months after transplantation, symptoms can fluctuate as the patient recovers. However, a new burning sensation confined to one leg requires assessment. We should first exclude deep vein thrombosis. I recommend that Ivana see her family doctor and have an ultrasound examination of the leg veins. This is a straightforward test that can usually be arranged quickly. If the ultrasound is normal and there is no thrombosis, physiotherapy and appropriate physical activity may help. B-vitamin supplements may also be discussed with her treating physician. Regarding her MRI, January is relatively soon; based on this description alone, I would keep the currently planned appointment rather than bringing it forward. First, please check the leg with ultrasound.
ADMINISTRATOR — ANASTASIA. Thank you. She should follow the doctor's advice and email me an update. Doctor, another patient who couldn't join us live asks about the risk of developing cancer after transplantation, both in the short term and in the long term. What can you tell us?
SPEAKER — DR. DENIS FEDORENKO. When centers first began using transplantation for autoimmune diseases in the late 1990s and early 2000s, they often adapted aggressive myeloablative regimens from leukemia treatment. Some of those earlier protocols were associated with a higher risk of secondary malignancies. In our experience, the modern protocol we use has not shown an increased short- or long-term cancer risk compared with the general population.
ADMINISTRATOR — ANASTASIA. . Because this protocol is very safe. Okay. Thank you again Dr.
PARTICIPANT. I've been receiving Ocrevus for the past four years. Does this treatment reduce my chances of recovering or achieving remission after your transplantation procedure?
SPEAKER — DR. DENIS FEDORENKO. Ocrevus is an anti-B-cell therapy. Before accepting a patient, we carry out a general medical examination, neurological assessment and MRI review. Four years of Ocrevus is a relatively long course of anti-B-cell treatment. As I said earlier, MS involves T cells as well as B cells. Ocrevus is among the more effective conventional disease-modifying therapies, but in our view its effect is primarily to delay disability. A concern in some patients is progression independent of relapse activity, or PIRA: disability can increase even when MRI findings remain stable. We have discussed a possible role for ongoing T-cell activity after prolonged B-cell depletion. This pattern can be difficult to manage with conventional medications.
Transplantation may still help, although the success rates in more heavily pretreated, progressive patients may be closer to 60–70% rather than 90%. If a person has remained clinically stable on Ocrevus for four or five years, we may discuss future treatment options, including whether and when to stop the drug and consider transplantation. Our protocol generally requires approximately three months between the last Ocrevus dose and transplantation. The final decision follows individual assessment.
PARTICIPANT. One last question, Doctor. I've spoken with neurologists who suggest that refrigerated stem cells may be preferable to frozen cells. Could you explain the advantages of freezing collected stem cells, as you do in Russia, rather than simply keeping them cold?
SPEAKER — DR. DENIS FEDORENKO. After collection, stem cells can be kept unfrozen at approximately 2–6°C for only a limited period, around 48 hours under the conditions we're discussing. Their viability decreases with extended storage. Our conditioning program takes six days, so simply leaving collected cells refrigerated throughout that period would lead to considerable loss of viable cells. We therefore cryopreserve them. Modern freezing techniques and cryoprotective agents allow us to preserve the cells safely, and our team has experience minimizing related side effects. Some centers that use a shorter, two-day chemotherapy program may be able to work with refrigerated cells, because the storage interval is much shorter. With our six-day regimen, cryopreservation is the appropriate option.
PARTICIPANT. One final question, Doctor. I've been told my EDSS score is 6.5, but I don't think that's correct because I can still walk. I've also been told that my disease is changing from relapsing-remitting to progressive MS. What do you think?
SPEAKER — DR. DENIS FEDORENKO. The transition from relapsing-remitting to secondary progressive MS does not happen overnight; it can take months or years. That transition is one reason to consider transplantation before advanced disability develops. The EDSS score can be assessed clinically. An EDSS score of 6.5 generally indicates that someone needs bilateral support to walk; using one walking aid corresponds more closely to 6.0. Walking a longer distance without an aid can indicate a lower score, depending on the full neurological examination. If you come to our hospital, our neurologist will assess your EDSS and review contrast-enhanced MRI of the brain, cervical spine and thoracic spine before treatment. We would establish an accurate baseline score rather than relying on the previously reported figure.
ADMINISTRATOR — ANASTASIA. I have a question from the chat: is there a risk of developing another autoimmune disease after HSCT?
SPEAKER — DR. DENIS FEDORENKO. Secondary autoimmune diseases are an important concern with some conditioning programs, particularly those that include antithymocyte globulin (ATG) or certain monoclonal antibodies, such as alemtuzumab (Campath, anti-CD52). We stopped using those agents in our MS transplantation protocol more than ten years ago. In earlier experience, the risk of secondary autoimmune disease with ATG was approximately 3–5%; in our follow-up with the current protocol, we have not observed such cases. We have discussed these findings with Professor Richard Burt from Chicago. We do not believe adding ATG improves our clinical outcomes. We also have not observed the same Epstein–Barr virus reactivation concerns with our current approach, which may include rituximab in selected circumstances.
ADMINISTRATOR — ANASTASIA. We have another question: under what circumstances would you prescribe antivirals, antibiotics or antifungal medication for several months after transplantation?
SPEAKER — DR. DENIS FEDORENKO. More than five years ago, we routinely prescribed medications such as co-trimoxazole and antivirals for several months after transplantation. We stopped doing this because, in our experience, we did not see a meaningful difference in infection rates. We did, however, observe drug-related liver toxicity, allergies and concerns about antimicrobial resistance. Long-term prophylaxis can select resistant bacteria, making subsequent infections more difficult to treat. We now reserve prophylactic antibiotics, antivirals or antifungals for a small subgroup of higher-risk patients, for example those with severe disability, urinary problems or a catheter after discharge. For most patients, these medicines are prescribed only when there is an actual indication, such as an infection.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. It's good to know that most patients won't need to keep taking so many medications after discharge. A positive mindset, healthy lifestyle, physical activity and perhaps vitamin D are important. Patients already receive many medicines during chemotherapy, so reducing unnecessary medication afterward is welcome.
SPEAKER — DR. DENIS FEDORENKO. During the month in hospital, patients receive antimicrobial protection as needed, including antiviral, antibacterial and antifungal medications, especially during protective isolation. After discharge, for most patients we monitor rather than continue routine prophylaxis. We prescribe medication if there is an actual infection or another clear indication.
ADMINISTRATOR — ANASTASIA. Thank you for explaining the different stages of treatment. Another question: what is your opinion of BEAM-like conditioning protocols?
SPEAKER — DR. DENIS FEDORENKO. We stopped using BEAM and BEAM-like conditioning protocols more than ten years ago. BEAM was originally developed for hematological malignancies and includes several agents with myeloablative toxicity. In our assessment, it is more toxic and offers no clear advantage over cyclophosphamide- or fludarabine/cyclophosphamide-based conditioning for MS. Some centers still use BEAM-like regimens, but many centers in the United States and Europe have shifted toward other approaches. BEAM was developed decades ago for lymphoma, not originally for MS. Early transplantation programs adapted these cancer regimens. I recall a Brazilian comparison reported around 2011 that assessed cyclophosphamide-based approaches against BEAM.
In my recollection, the BEAM group had important toxicity, including treatment-related mortality and late adverse effects, without better effectiveness. For that reason, we regard it as unnecessarily intensive for our MS program.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. A participant has a follow-up question about his friend, who has trouble regulating his body temperature, including sweating. Could transplantation help with that symptom?
SPEAKER — DR. DENIS FEDORENKO. I hope treatment will help. Difficulty regulating body temperature is not a common MS symptom, but it may relate to lesions in the brainstem or other areas involved in autonomic control. We need to examine him carefully and review his MRI before estimating his chance of improvement. Overall quality of life often improves after treatment in our patients, but I cannot guarantee that this particular symptom will resolve.
ADMINISTRATOR — ANASTASIA. Thank you. I have another question from the audience: does a patient need to be mentally very strong to undergo transplantation? How difficult is the treatment and recovery for someone who already experiences anxiety?
SPEAKER — DR. DENIS FEDORENKO. Motivation and a positive attitude can help people face difficult situations, including illness and its treatment. If anxiety or depression is significant, we can use appropriate supportive care or antidepressant medication. Treatment is medication-based, not surgery: it involves tablets, infusions and careful monitoring. In our current protocol, we consider it manageable and not inherently painful. The hospital staff offer practical and psychological support throughout the process. If we identify severe anxiety or other psychological needs, we discuss additional interventions and medications. We pay close attention to patients' symptoms, quality of life and individual needs rather than focusing only on the disease.
ADMINISTRATOR — ANASTASIA. We have patients who are already taking antidepressant medication when they arrive, and they can often continue it during transplantation with the medical team's supervision. For some people that support is very helpful.
PARTICIPANT. I'm 49 years old, and I was diagnosed with relapsing-remitting MS three years ago. I've lost some strength in my left leg. I follow a paleo diet and take vitamin D and magnesium. I also traveled to Colombia for stem cell treatment. Donor stem cells were administered twice by lumbar puncture, and I received intravenous treatments that included exosomes. Some of my minor symptoms have improved, but my left leg remains my main problem. My girlfriend suggested I consider transplantation with chemotherapy at your center. Her mother was treated there previously, although she had progressive MS and did not experience major functional recovery.
If I undergo your treatment, is there a chance my walking and left-leg strength could improve, or is the damage permanent because of the lesions in my brain?
SPEAKER — DR. DENIS FEDORENKO. This is an important question for many people with MS. You have a relatively short history of the disease, but walking and balance problems may indicate spinal cord involvement. Significant spinal lesions early in relapsing-remitting MS can be associated with a higher risk of accumulating disability. One major goal of transplantation is to halt disease activity and prevent further loss of mobility. Some people improve to the functional level they had one or one and a half years earlier, particularly if symptoms are recent, although the degree of recovery varies. The key distinction is that transplantation is directed at the abnormal immune process; it does not automatically reverse established nerve damage. After immune-directed treatment, rehabilitation becomes very important.
We also see interest in regenerative approaches, including mesenchymal stem cells, induced pluripotent stem cells and exosomes. However, those technologies should not be confused with AHSCT. My analogy is a house on fire: it makes little sense to repair the house without first extinguishing the fire. We must first control the autoimmune process. Further neurological recovery may then be helped by rehabilitation and, perhaps in the future, regenerative technologies. I would need to review your imaging to discuss your individual outlook.
PARTICIPANT. My brain MRI showed four lesions. They didn't identify current lesions in my spinal cord, although they did mention signs of an older problem there.
SPEAKER — DR. DENIS FEDORENKO. Was the cervical and thoracic spine examined, or only the neck? In MS assessment, we need imaging of the brain, cervical spine and thoracic spine. Signs of previous spinal involvement are relevant even when there are no large active lesions now. It is encouraging that there are no large lesions currently, although we still need to assess your clinical examination and images.
PARTICIPANT. My final question is about duration. Can transplantation keep MS under control for five years, ten years or possibly much longer?
SPEAKER — DR. DENIS FEDORENKO. We aim for remission that lasts throughout the patient's life. We have patients who received transplantation ten or fifteen years ago, and some Russian patients treated around 2005–2007 who remain in remission without post-transplant MS medication. Our international program began in 2011, so we also have substantial follow-up in that group. When I describe transplantation as potentially curative, I mean the possibility of lasting remission rather than a treatment intended to work for only a few years.
PARTICIPANT. May I ask one more question? I've heard the chemotherapy is very intensive. Is the treatment severe?
SPEAKER — DR. DENIS FEDORENKO. The older transplantation protocols were intensive anti-cancer or anti-leukemia regimens. Our current fludarabine/cyclophosphamide-based program is designed to be safer. In our experience with this regimen, we have not required intensive care admissions and have reported no treatment-related mortality in the group we are discussing. The main adverse effects we highlight are hair loss and mild to moderate fatigue during the first one to three months.
PARTICIPANT. Given the current situation involving Russia and Ukraine, is it still safe to travel to Russia for treatment?
SPEAKER — DR. DENIS FEDORENKO. That's an understandable question. The international political situation and sanctions have made travel arrangements more complicated, particularly because direct flights may be unavailable. However, according to our experience, international patients continue to travel to our hospital. Anastasia and our administrative partners can help explain connecting flights and the logistics of a trip to Moscow. As for local safety, I encourage you to speak with patients who are currently staying at the hospital, including people from Australia and European countries, and ask about their firsthand experience. Some share photos and accounts of excursions and restaurants on social media. Anastasia can help you connect with them.
We continue to provide treatment and organize hospital admissions despite the difficulties.
PARTICIPANT. So perhaps it would be a good choice to undergo the treatment while I still have RRMS, before it becomes progressive?
SPEAKER — DR. DENIS FEDORENKO. Yes. If the disease is still relapsing-remitting, we believe earlier treatment offers better prospects than waiting until it becomes secondary progressive. The outcomes we report are more favorable for RRMS than for SPMS. We would be glad to assess you.
PARTICIPANT. And what is the exact cost of treatment?
SPEAKER — DR. DENIS FEDORENKO. Anastasia can give you an accurate quotation and explain the administrative details. I believe the price is around 53,000 EUR, but I am responsible for the clinical treatment rather than finances, so please confirm the amount with her. Costs in Russia are lower than the figures I've seen published for similar transplantation programs in the United States, which may be around $89,000 to $125,000.
PARTICIPANT. Will you personally be overseeing patients while they're receiving treatment?
SPEAKER — DR. DENIS FEDORENKO. I oversee treatment for MS and other autoimmune disorders. We also work with systemic sclerosis, lupus and certain rare autoimmune neurological diseases, including inflammatory polyneuropathies and stiff-person syndrome. For example, Céline Dion has publicly discussed stiff-person syndrome. Our center has treated several patients with severe forms of that condition, with encouraging outcomes in our experience. Nevertheless, MS accounts for our largest group of patients and our greatest experience.
PARTICIPANT. I hope I'll have the chance to meet you in person one day.
SPEAKER — DR. DENIS FEDORENKO. Thank you. You're welcome.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. For travel and other organizational questions, patients can contact me by email through the hospital website. We can explain the arrangements and help with arrival at the airport. I have another question from a viewer: have you heard of an experimental treatment intended to repair MS-related nerve damage and restore lost function? The viewer didn't mention its name, so perhaps you can comment on the field generally.
SPEAKER — DR. DENIS FEDORENKO. A number of research teams have investigated potential remyelinating and regenerative treatments over the last ten to fifteen years. At present, in my view, there is no well-established medication or procedure that reliably restores major nerve damage in MS. This includes treatments advertised as mesenchymal stem cell therapy. Induced pluripotent stem cells, or iPS cells, are an interesting experimental direction because of their potential applications in nervous system repair, but clinical development is still at an early stage and may take many years. For now, preventing further disability remains the priority. The earlier we control MS activity, the more function may be preserved.
Rehabilitation with a qualified specialist is currently a practical way to work on mobility and residual impairments.
ADMINISTRATOR — ANASTASIA. I agree. Having worked at the hospital for more than ten years, I've seen that the most demanding part is often the rehabilitation after transplantation, rather than chemotherapy or the isolation period. Recovery requires patients to work with their bodies consistently, sometimes for months or years. Exercise and physical rehabilitation need to become part of everyday life. Waiting passively for function to return is unlikely to produce the same results.
SPEAKER — DR. DENIS FEDORENKO. I agree. One example is a former patient who previously used a wheelchair and later became highly active in sport. She has described a structured rehabilitation approach, but that kind of progress takes sustained work. Not everyone needs to become an athlete. For people without significant disability, ordinary fitness, yoga or Pilates may be appropriate. People with severe disability and muscle atrophy may need much more intensive, carefully supervised rehabilitation. We would all like an easy treatment or a 'magic pill,' but recovery often requires persistent effort.
ADMINISTRATOR — ANASTASIA. Thank you. Another question: can patients undergo transplantation if their MRI shows no active lesions?
SPEAKER — DR. DENIS FEDORENKO. Yes. We have not found a clear difference in transplantation outcomes between patients whose MRI scans show active lesions and those without active lesions. MS can progress clinically even when the MRI appears stable. The absence of gadolinium-enhancing lesions does not necessarily mean there is no ongoing inflammatory disease activity. Sometimes patients with no active MRI lesions respond to corticosteroids, which also suggests an inflammatory component. Our treatment targets the immune processes involving T and B cells. We may consider transplantation even without enhancing lesions when there is clinical progression or relapses and the overall assessment supports treatment.
ADMINISTRATOR — ANASTASIA. Thank you for clarifying. We have another participant who would like to ask a follow-up question live.
PARTICIPANT. Hello again. My friend uses a wheelchair and sometimes develops infected pressure sores. Must those wounds or infections be completely healed before transplantation?
SPEAKER — DR. DENIS FEDORENKO. If a pressure sore has an active infection, we should treat it before the intensive stage of transplantation. If a patient arrives with an unresolved infection, we may be able to manage it during the preparation period or extend that period to allow additional treatment. For patients who use a wheelchair or have significant disability, we also involve our rehabilitation team to provide appropriate support.
PARTICIPANT. Hello again. I have another question. What do you think about Dr. Ruiz's protocol in Mexico? I know there are differences in freezing versus refrigerated storage of stem cells, but what are the other differences between that approach and yours?
SPEAKER — DR. DENIS FEDORENKO. You mean the Mexico approach? Their private clinics may provide outpatient transplantation. I know that many people with MS have received treatment in Mexico and some have reported good results. The main difference we discuss is dose intensity. In one approach, cyclophosphamide is administered in separate courses with a break between them. In other programs, the same total dose is administered over consecutive days. Concentrating treatment into a shorter period can lead to a different intensity of immune depletion. Our program uses six consecutive days of conditioning and is performed in hospital. Under Russian regulations, transplantation is conducted in large academic or university hospitals with specific infection-control procedures.
Mexico may use shorter chemotherapy courses, which also affects the timing and storage of collected cells. We prefer a continuous, intensive inpatient approach with frozen stem cells. We do not yet have equally long follow-up for every alternative protocol, so I hope more comparative data will become available.
ADMINISTRATOR — ANASTASIA. This is a common question at our webinars. A former patient who underwent treatment some years ago and is feeling well asks: apart from taking vitamins, how can someone support their immune system during seasonal changes or while recovering from an illness?
SPEAKER — DR. DENIS FEDORENKO. For people who have recovered from transplantation, many recommendations are the same as for the general population: regular physical activity, adequate nutrition, a Mediterranean-style diet, appropriate vitamin supplementation and a positive mindset. Some people also like alternating warm and cool showers, although this is a lifestyle practice rather than a specific immune therapy. There is no simple medication that reliably makes the immune system 'stronger' in otherwise well patients. Intravenous immunoglobulin may be useful in certain patients with recurrent infections or immune deficiency, particularly early after treatment, but it is not a routine recommendation.
For someone more than a year after transplantation, immune recovery is generally much further advanced, and healthy lifestyle measures remain central.
ADMINISTRATOR — ANASTASIA. I'm pleased that we remain in touch with patients who underwent transplantation more than ten years ago and report no signs of MS progression. That speaks to the long-term outcomes we've been discussing. I'd also like to ask about rehabilitation: do you recommend a particular form of exercise or a mobility rehabilitation program, or does it depend on the individual?
SPEAKER — DR. DENIS FEDORENKO. Rehabilitation should be individualized. A person without major disability may benefit from ordinary physical activity, fitness, yoga or other suitable exercise. For someone with more severe disability, for example an EDSS score above 6, we recommend a personalized program with a rehabilitation specialist, appropriate equipment and regular supervised sessions, including support at home. The general principles of rehabilitation are similar across countries, but the specific program should reflect the patient's functional limitations.
ADMINISTRATOR — ANASTASIA. Thank you. We also received a question about ankylosing spondylitis: how many patients with this condition have received HSCT at your hospital, and what were the results?
SPEAKER — DR. DENIS FEDORENKO. I can give you the approximate number: we treated ten Russian patients with ankylosing spondylitis in a short clinical trial. We discontinued this work. Ankylosing spondylitis has inflammatory, degenerative and genetic components. Although we observed marked improvements after transplantation, they were generally short-lived, lasting approximately one to two years before the disease returned. Modern rheumatology offers effective biologic therapies, including anti-TNF agents, with outcomes that we consider at least as good for this condition. We therefore no longer offer HSCT for ankylosing spondylitis.
ADMINISTRATOR — ANASTASIA. Thank you. Could you also explain the treatment timeline? When are stem cells collected, when does chemotherapy begin, and where is the catheter placed?
SPEAKER — DR. DENIS FEDORENKO. The first stage is mobilization and collection of stem cells, usually during the first five to seven days. After approximately four days of stimulation, a catheter is placed for apheresis and subsequent treatment. We then give six days of chemotherapy, followed by one day for stem cell reinfusion. Protective isolation usually lasts six to eight days, and we observe the patient for another few days to confirm adequate recovery before discharge. In total, the hospital program usually takes about 25–30 days.
ADMINISTRATOR — ANASTASIA. This is a very useful question from a patient. Her MRI has remained stable during Ocrevus treatment, but she has continued to accumulate neurological disability. Could you explain progression independent of relapse activity—PIRA—and why this can happen despite stable imaging?
SPEAKER — DR. DENIS FEDORENKO. We touched on this earlier. PIRA stands for progression independent of relapse activity. It describes disability accumulation in the absence of overt relapses, sometimes with no new MRI activity. In the mechanism we're discussing, anti-B-cell treatment such as Ocrevus reduces B-cell activity and may stabilize the disease for some time, but ongoing T-cell-mediated processes may still contribute to progression. We consider transplantation a possible option in selected patients with progressive disability despite conventional treatment. Earlier assessment may offer a better opportunity to intervene. In this particular patient's case, we have agreed to assess her for transplantation because of her continuing neurological deterioration.
ADMINISTRATOR — ANASTASIA. Thank you. One of the final questions concerns fertility: can people have children after transplantation?
SPEAKER — DR. DENIS FEDORENKO. In our experience, many patients can have children after transplantation. However, anyone planning a pregnancy or future parenthood should consult a fertility or reproductive specialist before treatment and consider fertility preservation, such as sperm, oocyte or embryo cryopreservation, when appropriate. Modern conditioning regimens are less toxic to fertility than some older protocols, but no individual outcome can be guaranteed. Under our center's guidance, we recommend waiting at least one year after transplantation before pregnancy for women and at least three months before attempting conception for men.
ADMINISTRATOR — ANASTASIA. Thank you. Another frequent question concerns vaccinations. Do you recommend repeating childhood vaccinations after treatment? What is your general advice about vaccination after AHSCT?
SPEAKER — DR. DENIS FEDORENKO. Our protocol does not recommend automatically repeating all childhood vaccinations after AHSCT for autoimmune diseases. The reasoning we use is that existing antibodies are not necessarily eliminated by chemotherapy, even though immune cell populations change. We believe some vaccinations may be less effective early after treatment because of low B-cell counts, and we assess vaccination decisions individually. In our MS program, we advise vaccination when there is a specific medical or exposure-related indication, rather than recommending a blanket restart of the childhood schedule. Our recommendations for autoimmune disease patients differ from those used in some oncology transplantation programs.
ADMINISTRATOR — ANASTASIA. One related follow-up question: what about a live yellow fever vaccine two years after transplantation?
SPEAKER — DR. DENIS FEDORENKO. If someone lives in, or needs to travel to, an area where yellow fever is a real risk, vaccination should be discussed and provided when medically appropriate because yellow fever is a serious infection. If there is no risk of exposure, it may not be necessary. The decision requires individual clinical evaluation, especially for a live vaccine after transplantation.
ADMINISTRATOR — ANASTASIA. One last question: could you explain what protective isolation involves in hospital and for how long patients must avoid contact with other people afterward?
SPEAKER — DR. DENIS FEDORENKO. We do not recommend separating yourself from family and friends for months. After discharge, we generally advise using a mask in crowded places and avoiding close contact with ill people for about three months. The in-hospital protective isolation period usually lasts six to eight days. During that time the patient remains in a comfortable single room with special ventilation and HEPA filtration. Patients can read, use a computer or phone, and stay in touch with family by Wi-Fi and video calls. Isolation also involves more than staying inside the room: antiseptic and oral care, cleaning measures, daily blood tests, monitoring of vital signs and surveillance for signs of infection. During the period of very low immune cell counts, leaving the protected room could increase infection risk.
Fortunately, this phase is limited in duration, and patients can communicate normally with loved ones throughout it.
ADMINISTRATOR — ANASTASIA. That's true. Doctor, I think we've answered all the questions. I don't see any more. Good work today.
SPEAKER — DR. DENIS FEDORENKO. Yes, I think we answered many useful questions that also concern patients who couldn't join us. We'll make the recording available so others can watch and consider these answers. Dear friends, thank you for participating in our webinar. I wish you all the best. Stay safe and take care of yourselves. Thank you, Anastasia, and thanks to the team who helped organize this webinar.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. I wish everyone health and happiness. All the best from Moscow!
SPEAKER — DR. DENIS FEDORENKO. Those questions are important for many other people with advanced MS. Urinary incontinence is relatively common in advanced disease and can be associated with spinal cord damage. Our main objective in advanced MS is to stop further disease activity and improve quality of life. We cannot guarantee that incontinence will resolve, although some patients regain function they had a year or more earlier. Transplantation addresses the abnormal immune system; symptoms also require their own management. He should be assessed by a neuro-urologist, who can recommend medication and exercises or rehabilitation to improve bladder control. During transplantation, patients receive many infusions, and we use a urinary catheter during the relevant stage of treatment.
This allows our team to manage the problem. We also follow infection-prevention procedures. We will arrange appropriate support while he is in hospital and give detailed recommendations for rehabilitation and care at home. Regarding travel, we discharge patients when their immune counts have recovered to a level we consider safe for travel, although they may still be below normal. We recommend wearing a mask in crowded public places, including airports, for about three months and avoiding close contact with people who are ill. We do not recommend prolonged isolation from family and friends. Patients can normally take a commercial flight. If a respiratory or bacterial infection occurs, we assess and treat it as necessary.
Our recommendation is to take sensible precautions rather than to remain isolated.
PARTICIPANT. What supplements do you recommend after treatment? Vitamin D or anything else?
SPEAKER — DR. DENIS FEDORENKO. We recommend maintaining an adequate vitamin D level, generally in the range of 50–100 as quoted in our protocol, and taking a usual supplement dose rather than the high-dose Coimbra protocol. I commonly recommend 4,000–5,000 IU per day. Other supplements, such as multivitamins, B vitamins or magnesium, are optional. Symptomatic treatment should be tailored to each patient's problems; for urinary incontinence, medications such as solifenacin may be discussed with a neurologist or urologist. We do not routinely recommend antibiotics, antivirals or antifungals after discharge in uncomplicated cases.
PARTICIPANT. I was diagnosed at the end of July, after my first relapse in May this year. My EDSS score is 2, and I have not yet received disease-modifying therapy. Based on your presentation, I seem to be a good candidate for AHSCT. You described it as potentially curative. What are my chances of staying in remission for the rest of my life?
SPEAKER — DR. DENIS FEDORENKO. I understand your situation. Could you repeat which medication you're currently taking?
PARTICIPANT. Nothing. I'm treatment-naïve.
SPEAKER — DR. DENIS FEDORENKO. So you are treatment-naïve. As I said in the presentation, limited prior treatment is one of the factors associated with better results. Other favorable factors include early relapsing-remitting MS, an EDSS score below 4, a disease history of five years or less, and age under 40. Not every patient needs to meet all of these criteria. We classify patients into lower-, moderate- and higher-risk groups according to the number of unfavorable factors. In our low-risk group, which resembles your situation, the reported success rate is about 92–93%. We also consider our current transplantation protocol much safer than earlier approaches.
In our experience, common short-term effects include hair loss, tiredness during the first one to three months and some increased susceptibility to infections early in recovery. We have not observed a major increase in certain late complications with this regimen in our cohort. Transplantation is a one-time treatment lasting roughly one month; routine disease-modifying medication afterward is generally not part of our protocol. By contrast, disease-modifying therapies may need to be continued or changed over many years. We believe earlier intervention can offer a greater chance of preventing disability. We also treat people with progressive disease, but the success rates we report for more advanced cases are lower, at around 75%, than for early relapsing-remitting disease.
PARTICIPANT. Do you think it's possible for remission to last a lifetime? I know HSCT began about 30 years ago, so perhaps there isn't enough long-term data yet.
SPEAKER — DR. DENIS FEDORENKO. Okay. So, we have long-term followup. We have patients who received this treatment 15, 20 years ago and they still in remission not having a post-rplant treatment after transplantation. So, first transplantation in the world was performed in 1997. We performed first transplantation in Russia in 1999 and started our hospital in 2005 started our clinical trial and 10 years later on from 2010 we started to use this approach in routine clinical practice also this is legal and official treatment in Russia not governed by M Ministry of Health now but we Our government, our ministry, healthc care support this treatment and but of course we have some problems with big pharma with neurological society but this treatment is legal and we have more than 20 year of experience. It's long enough.
If you find new medication right now, we need to wait at least 5–10 years to understand how this medication can help us transplantation history. This is long history and this is history of course this is not the same approach like 20 years ago. We developed our protocol mainly from high toxicity to high safety saving treatment effectiveness. So this is why first results were a little bit worse than our new result but we have big group of patients with followup five and 10 years using our modern approaches and success rate is very high for from 75% for advanced progressive variance including primary progressive to 90 95% for early relapsing-remitting multiple sclerosis.
So this is if you compare with the most effective traditional treatment this is 0 20 25% for anti-B cells therapy and 90 95% for transplantation and nothing between.
PARTICIPANT. Does that 90–95% success rate also apply in the long term, over five to ten years?
SPEAKER — DR. DENIS FEDORENKO. Yes. These are event-free survival results. As shown in my presentation, we analyzed almost 1,000 patients over five years. We also have smaller groups with ten-year follow-up. We're talking about years, not months.
PARTICIPANT. Thank you, Doctor. One last question: what's the best way to prepare for transplantation and improve the chances of success? Should I exercise or follow a special diet before and after treatment?
SPEAKER — DR. DENIS FEDORENKO. First, if someone has a chronic infection, such as an untreated dental problem, it should be addressed before transplantation. It is also important to approach treatment with motivation and confidence. I encourage patients to have a positive mindset rather than focusing constantly on the possibility of failure. In addition, they should follow a healthy lifestyle. Research in neurology supports the benefits of a Mediterranean-style diet. We recommend vitamin D at a usual dose, approximately 4,000–5,000 IU per day, rather than exceptionally high doses, and regular exercise. Smoking is particularly relevant to MS. Research has linked smoking to more aggressive disease and poorer treatment outcomes.
We advise patients to reduce smoking and ideally stop completely, especially after transplantation. Having an occasional glass of wine is a separate issue; smoking is the greater concern we emphasize here. After transplantation, our protocol does not generally require continued disease-modifying treatment, but patients should maintain healthy habits: a positive mindset, balanced nutrition, physical activity and no smoking.
PARTICIPANT. I stopped smoking two months ago. I started when I was 14, and I'm 27 now.
SPEAKER — DR. DENIS FEDORENKO. If you've stopped, that's good. No problem.
ADMINISTRATOR — ANASTASIA. One of our former patients had transplantation in July this year. A few days ago she began experiencing a burning sensation in her right leg while resting, without any other new symptoms, and she is worried. Her next MRI is scheduled for January. Would you recommend moving it forward, and what should she do now?
SPEAKER — DR. DENIS FEDORENKO. During the early months after transplantation, symptoms can fluctuate as the patient recovers. However, a new burning sensation confined to one leg requires assessment. We should first exclude deep vein thrombosis. I recommend that Ivana see her family doctor and have an ultrasound examination of the leg veins. This is a straightforward test that can usually be arranged quickly. If the ultrasound is normal and there is no thrombosis, physiotherapy and appropriate physical activity may help. B-vitamin supplements may also be discussed with her treating physician. Regarding her MRI, January is relatively soon; based on this description alone, I would keep the currently planned appointment rather than bringing it forward. First, please check the leg with ultrasound.
ADMINISTRATOR — ANASTASIA. Thank you. She should follow the doctor's advice and email me an update. Doctor, another patient who couldn't join us live asks about the risk of developing cancer after transplantation, both in the short term and in the long term. What can you tell us?
SPEAKER — DR. DENIS FEDORENKO. When centers first began using transplantation for autoimmune diseases in the late 1990s and early 2000s, they often adapted aggressive myeloablative regimens from leukemia treatment. Some of those earlier protocols were associated with a higher risk of secondary malignancies. In our experience, the modern protocol we use has not shown an increased short- or long-term cancer risk compared with the general population.
ADMINISTRATOR — ANASTASIA. . Because this protocol is very safe. Okay. Thank you again Dr.
PARTICIPANT. I've been receiving Ocrevus for the past four years. Does this treatment reduce my chances of recovering or achieving remission after your transplantation procedure?
SPEAKER — DR. DENIS FEDORENKO. Ocrevus is an anti-B-cell therapy. Before accepting a patient, we carry out a general medical examination, neurological assessment and MRI review. Four years of Ocrevus is a relatively long course of anti-B-cell treatment. As I said earlier, MS involves T cells as well as B cells. Ocrevus is among the more effective conventional disease-modifying therapies, but in our view its effect is primarily to delay disability. A concern in some patients is progression independent of relapse activity, or PIRA: disability can increase even when MRI findings remain stable. We have discussed a possible role for ongoing T-cell activity after prolonged B-cell depletion. This pattern can be difficult to manage with conventional medications.
Transplantation may still help, although the success rates in more heavily pretreated, progressive patients may be closer to 60–70% rather than 90%. If a person has remained clinically stable on Ocrevus for four or five years, we may discuss future treatment options, including whether and when to stop the drug and consider transplantation. Our protocol generally requires approximately three months between the last Ocrevus dose and transplantation. The final decision follows individual assessment.
PARTICIPANT. One last question, Doctor. I've spoken with neurologists who suggest that refrigerated stem cells may be preferable to frozen cells. Could you explain the advantages of freezing collected stem cells, as you do in Russia, rather than simply keeping them cold?
SPEAKER — DR. DENIS FEDORENKO. After collection, stem cells can be kept unfrozen at approximately 2–6°C for only a limited period, around 48 hours under the conditions we're discussing. Their viability decreases with extended storage. Our conditioning program takes six days, so simply leaving collected cells refrigerated throughout that period would lead to considerable loss of viable cells. We therefore cryopreserve them. Modern freezing techniques and cryoprotective agents allow us to preserve the cells safely, and our team has experience minimizing related side effects. Some centers that use a shorter, two-day chemotherapy program may be able to work with refrigerated cells, because the storage interval is much shorter. With our six-day regimen, cryopreservation is the appropriate option.
PARTICIPANT. One final question, Doctor. I've been told my EDSS score is 6.5, but I don't think that's correct because I can still walk. I've also been told that my disease is changing from relapsing-remitting to progressive MS. What do you think?
SPEAKER — DR. DENIS FEDORENKO. The transition from relapsing-remitting to secondary progressive MS does not happen overnight; it can take months or years. That transition is one reason to consider transplantation before advanced disability develops. The EDSS score can be assessed clinically. An EDSS score of 6.5 generally indicates that someone needs bilateral support to walk; using one walking aid corresponds more closely to 6.0. Walking a longer distance without an aid can indicate a lower score, depending on the full neurological examination. If you come to our hospital, our neurologist will assess your EDSS and review contrast-enhanced MRI of the brain, cervical spine and thoracic spine before treatment. We would establish an accurate baseline score rather than relying on the previously reported figure.
ADMINISTRATOR — ANASTASIA. I have a question from the chat: is there a risk of developing another autoimmune disease after HSCT?
SPEAKER — DR. DENIS FEDORENKO. Secondary autoimmune diseases are an important concern with some conditioning programs, particularly those that include antithymocyte globulin (ATG) or certain monoclonal antibodies, such as alemtuzumab (Campath, anti-CD52). We stopped using those agents in our MS transplantation protocol more than ten years ago. In earlier experience, the risk of secondary autoimmune disease with ATG was approximately 3–5%; in our follow-up with the current protocol, we have not observed such cases. We have discussed these findings with Professor Richard Burt from Chicago. We do not believe adding ATG improves our clinical outcomes. We also have not observed the same Epstein–Barr virus reactivation concerns with our current approach, which may include rituximab in selected circumstances.
ADMINISTRATOR — ANASTASIA. We have another question: under what circumstances would you prescribe antivirals, antibiotics or antifungal medication for several months after transplantation?
SPEAKER — DR. DENIS FEDORENKO. More than five years ago, we routinely prescribed medications such as co-trimoxazole and antivirals for several months after transplantation. We stopped doing this because, in our experience, we did not see a meaningful difference in infection rates. We did, however, observe drug-related liver toxicity, allergies and concerns about antimicrobial resistance. Long-term prophylaxis can select resistant bacteria, making subsequent infections more difficult to treat. We now reserve prophylactic antibiotics, antivirals or antifungals for a small subgroup of higher-risk patients, for example those with severe disability, urinary problems or a catheter after discharge. For most patients, these medicines are prescribed only when there is an actual indication, such as an infection.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. It's good to know that most patients won't need to keep taking so many medications after discharge. A positive mindset, healthy lifestyle, physical activity and perhaps vitamin D are important. Patients already receive many medicines during chemotherapy, so reducing unnecessary medication afterward is welcome.
SPEAKER — DR. DENIS FEDORENKO. During the month in hospital, patients receive antimicrobial protection as needed, including antiviral, antibacterial and antifungal medications, especially during protective isolation. After discharge, for most patients we monitor rather than continue routine prophylaxis. We prescribe medication if there is an actual infection or another clear indication.
ADMINISTRATOR — ANASTASIA. Thank you for explaining the different stages of treatment. Another question: what is your opinion of BEAM-like conditioning protocols?
SPEAKER — DR. DENIS FEDORENKO. We stopped using BEAM and BEAM-like conditioning protocols more than ten years ago. BEAM was originally developed for hematological malignancies and includes several agents with myeloablative toxicity. In our assessment, it is more toxic and offers no clear advantage over cyclophosphamide- or fludarabine/cyclophosphamide-based conditioning for MS. Some centers still use BEAM-like regimens, but many centers in the United States and Europe have shifted toward other approaches. BEAM was developed decades ago for lymphoma, not originally for MS. Early transplantation programs adapted these cancer regimens. I recall a Brazilian comparison reported around 2011 that assessed cyclophosphamide-based approaches against BEAM.
In my recollection, the BEAM group had important toxicity, including treatment-related mortality and late adverse effects, without better effectiveness. For that reason, we regard it as unnecessarily intensive for our MS program.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. A participant has a follow-up question about his friend, who has trouble regulating his body temperature, including sweating. Could transplantation help with that symptom?
SPEAKER — DR. DENIS FEDORENKO. I hope treatment will help. Difficulty regulating body temperature is not a common MS symptom, but it may relate to lesions in the brainstem or other areas involved in autonomic control. We need to examine him carefully and review his MRI before estimating his chance of improvement. Overall quality of life often improves after treatment in our patients, but I cannot guarantee that this particular symptom will resolve.
ADMINISTRATOR — ANASTASIA. Thank you. I have another question from the audience: does a patient need to be mentally very strong to undergo transplantation? How difficult is the treatment and recovery for someone who already experiences anxiety?
SPEAKER — DR. DENIS FEDORENKO. Motivation and a positive attitude can help people face difficult situations, including illness and its treatment. If anxiety or depression is significant, we can use appropriate supportive care or antidepressant medication. Treatment is medication-based, not surgery: it involves tablets, infusions and careful monitoring. In our current protocol, we consider it manageable and not inherently painful. The hospital staff offer practical and psychological support throughout the process. If we identify severe anxiety or other psychological needs, we discuss additional interventions and medications. We pay close attention to patients' symptoms, quality of life and individual needs rather than focusing only on the disease.
ADMINISTRATOR — ANASTASIA. We have patients who are already taking antidepressant medication when they arrive, and they can often continue it during transplantation with the medical team's supervision. For some people that support is very helpful.
PARTICIPANT. I'm 49 years old, and I was diagnosed with relapsing-remitting MS three years ago. I've lost some strength in my left leg. I follow a paleo diet and take vitamin D and magnesium. I also traveled to Colombia for stem cell treatment. Donor stem cells were administered twice by lumbar puncture, and I received intravenous treatments that included exosomes. Some of my minor symptoms have improved, but my left leg remains my main problem. My girlfriend suggested I consider transplantation with chemotherapy at your center. Her mother was treated there previously, although she had progressive MS and did not experience major functional recovery.
If I undergo your treatment, is there a chance my walking and left-leg strength could improve, or is the damage permanent because of the lesions in my brain?
SPEAKER — DR. DENIS FEDORENKO. This is an important question for many people with MS. You have a relatively short history of the disease, but walking and balance problems may indicate spinal cord involvement. Significant spinal lesions early in relapsing-remitting MS can be associated with a higher risk of accumulating disability. One major goal of transplantation is to halt disease activity and prevent further loss of mobility. Some people improve to the functional level they had one or one and a half years earlier, particularly if symptoms are recent, although the degree of recovery varies. The key distinction is that transplantation is directed at the abnormal immune process; it does not automatically reverse established nerve damage. After immune-directed treatment, rehabilitation becomes very important.
We also see interest in regenerative approaches, including mesenchymal stem cells, induced pluripotent stem cells and exosomes. However, those technologies should not be confused with AHSCT. My analogy is a house on fire: it makes little sense to repair the house without first extinguishing the fire. We must first control the autoimmune process. Further neurological recovery may then be helped by rehabilitation and, perhaps in the future, regenerative technologies. I would need to review your imaging to discuss your individual outlook.
PARTICIPANT. My brain MRI showed four lesions. They didn't identify current lesions in my spinal cord, although they did mention signs of an older problem there.
SPEAKER — DR. DENIS FEDORENKO. Was the cervical and thoracic spine examined, or only the neck? In MS assessment, we need imaging of the brain, cervical spine and thoracic spine. Signs of previous spinal involvement are relevant even when there are no large active lesions now. It is encouraging that there are no large lesions currently, although we still need to assess your clinical examination and images.
PARTICIPANT. My final question is about duration. Can transplantation keep MS under control for five years, ten years or possibly much longer?
SPEAKER — DR. DENIS FEDORENKO. We aim for remission that lasts throughout the patient's life. We have patients who received transplantation ten or fifteen years ago, and some Russian patients treated around 2005–2007 who remain in remission without post-transplant MS medication. Our international program began in 2011, so we also have substantial follow-up in that group. When I describe transplantation as potentially curative, I mean the possibility of lasting remission rather than a treatment intended to work for only a few years.
PARTICIPANT. May I ask one more question? I've heard the chemotherapy is very intensive. Is the treatment severe?
SPEAKER — DR. DENIS FEDORENKO. The older transplantation protocols were intensive anti-cancer or anti-leukemia regimens. Our current fludarabine/cyclophosphamide-based program is designed to be safer. In our experience with this regimen, we have not required intensive care admissions and have reported no treatment-related mortality in the group we are discussing. The main adverse effects we highlight are hair loss and mild to moderate fatigue during the first one to three months.
PARTICIPANT. Given the current situation involving Russia and Ukraine, is it still safe to travel to Russia for treatment?
SPEAKER — DR. DENIS FEDORENKO. That's an understandable question. The international political situation and sanctions have made travel arrangements more complicated, particularly because direct flights may be unavailable. However, according to our experience, international patients continue to travel to our hospital. Anastasia and our administrative partners can help explain connecting flights and the logistics of a trip to Moscow. As for local safety, I encourage you to speak with patients who are currently staying at the hospital, including people from Australia and European countries, and ask about their firsthand experience. Some share photos and accounts of excursions and restaurants on social media. Anastasia can help you connect with them.
We continue to provide treatment and organize hospital admissions despite the difficulties.
PARTICIPANT. So perhaps it would be a good choice to undergo the treatment while I still have RRMS, before it becomes progressive?
SPEAKER — DR. DENIS FEDORENKO. Yes. If the disease is still relapsing-remitting, we believe earlier treatment offers better prospects than waiting until it becomes secondary progressive. The outcomes we report are more favorable for RRMS than for SPMS. We would be glad to assess you.
PARTICIPANT. And what is the exact cost of treatment?
SPEAKER — DR. DENIS FEDORENKO. Anastasia can give you an accurate quotation and explain the administrative details. I believe the price is around 53,000 EUR, but I am responsible for the clinical treatment rather than finances, so please confirm the amount with her. Costs in Russia are lower than the figures I've seen published for similar transplantation programs in the United States, which may be around $89,000 to $125,000.
PARTICIPANT. Will you personally be overseeing patients while they're receiving treatment?
SPEAKER — DR. DENIS FEDORENKO. I oversee treatment for MS and other autoimmune disorders. We also work with systemic sclerosis, lupus and certain rare autoimmune neurological diseases, including inflammatory polyneuropathies and stiff-person syndrome. For example, Céline Dion has publicly discussed stiff-person syndrome. Our center has treated several patients with severe forms of that condition, with encouraging outcomes in our experience. Nevertheless, MS accounts for our largest group of patients and our greatest experience.
PARTICIPANT. I hope I'll have the chance to meet you in person one day.
SPEAKER — DR. DENIS FEDORENKO. Thank you. You're welcome.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. For travel and other organizational questions, patients can contact me by email through the hospital website. We can explain the arrangements and help with arrival at the airport. I have another question from a viewer: have you heard of an experimental treatment intended to repair MS-related nerve damage and restore lost function? The viewer didn't mention its name, so perhaps you can comment on the field generally.
SPEAKER — DR. DENIS FEDORENKO. A number of research teams have investigated potential remyelinating and regenerative treatments over the last ten to fifteen years. At present, in my view, there is no well-established medication or procedure that reliably restores major nerve damage in MS. This includes treatments advertised as mesenchymal stem cell therapy. Induced pluripotent stem cells, or iPS cells, are an interesting experimental direction because of their potential applications in nervous system repair, but clinical development is still at an early stage and may take many years. For now, preventing further disability remains the priority. The earlier we control MS activity, the more function may be preserved.
Rehabilitation with a qualified specialist is currently a practical way to work on mobility and residual impairments.
ADMINISTRATOR — ANASTASIA. I agree. Having worked at the hospital for more than ten years, I've seen that the most demanding part is often the rehabilitation after transplantation, rather than chemotherapy or the isolation period. Recovery requires patients to work with their bodies consistently, sometimes for months or years. Exercise and physical rehabilitation need to become part of everyday life. Waiting passively for function to return is unlikely to produce the same results.
SPEAKER — DR. DENIS FEDORENKO. I agree. One example is a former patient who previously used a wheelchair and later became highly active in sport. She has described a structured rehabilitation approach, but that kind of progress takes sustained work. Not everyone needs to become an athlete. For people without significant disability, ordinary fitness, yoga or Pilates may be appropriate. People with severe disability and muscle atrophy may need much more intensive, carefully supervised rehabilitation. We would all like an easy treatment or a 'magic pill,' but recovery often requires persistent effort.
ADMINISTRATOR — ANASTASIA. Thank you. Another question: can patients undergo transplantation if their MRI shows no active lesions?
SPEAKER — DR. DENIS FEDORENKO. Yes. We have not found a clear difference in transplantation outcomes between patients whose MRI scans show active lesions and those without active lesions. MS can progress clinically even when the MRI appears stable. The absence of gadolinium-enhancing lesions does not necessarily mean there is no ongoing inflammatory disease activity. Sometimes patients with no active MRI lesions respond to corticosteroids, which also suggests an inflammatory component. Our treatment targets the immune processes involving T and B cells. We may consider transplantation even without enhancing lesions when there is clinical progression or relapses and the overall assessment supports treatment.
ADMINISTRATOR — ANASTASIA. Thank you for clarifying. We have another participant who would like to ask a follow-up question live.
PARTICIPANT. Hello again. My friend uses a wheelchair and sometimes develops infected pressure sores. Must those wounds or infections be completely healed before transplantation?
SPEAKER — DR. DENIS FEDORENKO. If a pressure sore has an active infection, we should treat it before the intensive stage of transplantation. If a patient arrives with an unresolved infection, we may be able to manage it during the preparation period or extend that period to allow additional treatment. For patients who use a wheelchair or have significant disability, we also involve our rehabilitation team to provide appropriate support.
PARTICIPANT. Hello again. I have another question. What do you think about Dr. Ruiz's protocol in Mexico? I know there are differences in freezing versus refrigerated storage of stem cells, but what are the other differences between that approach and yours?
SPEAKER — DR. DENIS FEDORENKO. You mean the Mexico approach? Their private clinics may provide outpatient transplantation. I know that many people with MS have received treatment in Mexico and some have reported good results. The main difference we discuss is dose intensity. In one approach, cyclophosphamide is administered in separate courses with a break between them. In other programs, the same total dose is administered over consecutive days. Concentrating treatment into a shorter period can lead to a different intensity of immune depletion. Our program uses six consecutive days of conditioning and is performed in hospital. Under Russian regulations, transplantation is conducted in large academic or university hospitals with specific infection-control procedures.
Mexico may use shorter chemotherapy courses, which also affects the timing and storage of collected cells. We prefer a continuous, intensive inpatient approach with frozen stem cells. We do not yet have equally long follow-up for every alternative protocol, so I hope more comparative data will become available.
ADMINISTRATOR — ANASTASIA. This is a common question at our webinars. A former patient who underwent treatment some years ago and is feeling well asks: apart from taking vitamins, how can someone support their immune system during seasonal changes or while recovering from an illness?
SPEAKER — DR. DENIS FEDORENKO. For people who have recovered from transplantation, many recommendations are the same as for the general population: regular physical activity, adequate nutrition, a Mediterranean-style diet, appropriate vitamin supplementation and a positive mindset. Some people also like alternating warm and cool showers, although this is a lifestyle practice rather than a specific immune therapy. There is no simple medication that reliably makes the immune system 'stronger' in otherwise well patients. Intravenous immunoglobulin may be useful in certain patients with recurrent infections or immune deficiency, particularly early after treatment, but it is not a routine recommendation.
For someone more than a year after transplantation, immune recovery is generally much further advanced, and healthy lifestyle measures remain central.
ADMINISTRATOR — ANASTASIA. I'm pleased that we remain in touch with patients who underwent transplantation more than ten years ago and report no signs of MS progression. That speaks to the long-term outcomes we've been discussing. I'd also like to ask about rehabilitation: do you recommend a particular form of exercise or a mobility rehabilitation program, or does it depend on the individual?
SPEAKER — DR. DENIS FEDORENKO. Rehabilitation should be individualized. A person without major disability may benefit from ordinary physical activity, fitness, yoga or other suitable exercise. For someone with more severe disability, for example an EDSS score above 6, we recommend a personalized program with a rehabilitation specialist, appropriate equipment and regular supervised sessions, including support at home. The general principles of rehabilitation are similar across countries, but the specific program should reflect the patient's functional limitations.
ADMINISTRATOR — ANASTASIA. Thank you. We also received a question about ankylosing spondylitis: how many patients with this condition have received HSCT at your hospital, and what were the results?
SPEAKER — DR. DENIS FEDORENKO. I can give you the approximate number: we treated ten Russian patients with ankylosing spondylitis in a short clinical trial. We discontinued this work. Ankylosing spondylitis has inflammatory, degenerative and genetic components. Although we observed marked improvements after transplantation, they were generally short-lived, lasting approximately one to two years before the disease returned. Modern rheumatology offers effective biologic therapies, including anti-TNF agents, with outcomes that we consider at least as good for this condition. We therefore no longer offer HSCT for ankylosing spondylitis.
ADMINISTRATOR — ANASTASIA. Thank you. Could you also explain the treatment timeline? When are stem cells collected, when does chemotherapy begin, and where is the catheter placed?
SPEAKER — DR. DENIS FEDORENKO. The first stage is mobilization and collection of stem cells, usually during the first five to seven days. After approximately four days of stimulation, a catheter is placed for apheresis and subsequent treatment. We then give six days of chemotherapy, followed by one day for stem cell reinfusion. Protective isolation usually lasts six to eight days, and we observe the patient for another few days to confirm adequate recovery before discharge. In total, the hospital program usually takes about 25–30 days.
ADMINISTRATOR — ANASTASIA. This is a very useful question from a patient. Her MRI has remained stable during Ocrevus treatment, but she has continued to accumulate neurological disability. Could you explain progression independent of relapse activity—PIRA—and why this can happen despite stable imaging?
SPEAKER — DR. DENIS FEDORENKO. We touched on this earlier. PIRA stands for progression independent of relapse activity. It describes disability accumulation in the absence of overt relapses, sometimes with no new MRI activity. In the mechanism we're discussing, anti-B-cell treatment such as Ocrevus reduces B-cell activity and may stabilize the disease for some time, but ongoing T-cell-mediated processes may still contribute to progression. We consider transplantation a possible option in selected patients with progressive disability despite conventional treatment. Earlier assessment may offer a better opportunity to intervene. In this particular patient's case, we have agreed to assess her for transplantation because of her continuing neurological deterioration.
ADMINISTRATOR — ANASTASIA. Thank you. One of the final questions concerns fertility: can people have children after transplantation?
SPEAKER — DR. DENIS FEDORENKO. In our experience, many patients can have children after transplantation. However, anyone planning a pregnancy or future parenthood should consult a fertility or reproductive specialist before treatment and consider fertility preservation, such as sperm, oocyte or embryo cryopreservation, when appropriate. Modern conditioning regimens are less toxic to fertility than some older protocols, but no individual outcome can be guaranteed. Under our center's guidance, we recommend waiting at least one year after transplantation before pregnancy for women and at least three months before attempting conception for men.
ADMINISTRATOR — ANASTASIA. Thank you. Another frequent question concerns vaccinations. Do you recommend repeating childhood vaccinations after treatment? What is your general advice about vaccination after AHSCT?
SPEAKER — DR. DENIS FEDORENKO. Our protocol does not recommend automatically repeating all childhood vaccinations after AHSCT for autoimmune diseases. The reasoning we use is that existing antibodies are not necessarily eliminated by chemotherapy, even though immune cell populations change. We believe some vaccinations may be less effective early after treatment because of low B-cell counts, and we assess vaccination decisions individually. In our MS program, we advise vaccination when there is a specific medical or exposure-related indication, rather than recommending a blanket restart of the childhood schedule. Our recommendations for autoimmune disease patients differ from those used in some oncology transplantation programs.
ADMINISTRATOR — ANASTASIA. One related follow-up question: what about a live yellow fever vaccine two years after transplantation?
SPEAKER — DR. DENIS FEDORENKO. If someone lives in, or needs to travel to, an area where yellow fever is a real risk, vaccination should be discussed and provided when medically appropriate because yellow fever is a serious infection. If there is no risk of exposure, it may not be necessary. The decision requires individual clinical evaluation, especially for a live vaccine after transplantation.
ADMINISTRATOR — ANASTASIA. One last question: could you explain what protective isolation involves in hospital and for how long patients must avoid contact with other people afterward?
SPEAKER — DR. DENIS FEDORENKO. We do not recommend separating yourself from family and friends for months. After discharge, we generally advise using a mask in crowded places and avoiding close contact with ill people for about three months. The in-hospital protective isolation period usually lasts six to eight days. During that time the patient remains in a comfortable single room with special ventilation and HEPA filtration. Patients can read, use a computer or phone, and stay in touch with family by Wi-Fi and video calls. Isolation also involves more than staying inside the room: antiseptic and oral care, cleaning measures, daily blood tests, monitoring of vital signs and surveillance for signs of infection. During the period of very low immune cell counts, leaving the protected room could increase infection risk.
Fortunately, this phase is limited in duration, and patients can communicate normally with loved ones throughout it.
ADMINISTRATOR — ANASTASIA. That's true. Doctor, I think we've answered all the questions. I don't see any more. Good work today.
SPEAKER — DR. DENIS FEDORENKO. Yes, I think we answered many useful questions that also concern patients who couldn't join us. We'll make the recording available so others can watch and consider these answers. Dear friends, thank you for participating in our webinar. I wish you all the best. Stay safe and take care of yourselves. Thank you, Anastasia, and thanks to the team who helped organize this webinar.
ADMINISTRATOR — ANASTASIA. Thank you, Doctor. I wish everyone health and happiness. All the best from Moscow!
Webinar record
May 17 (2026)
Webinar record
December 21 (2025)
Friday 02, May (2025)
November 23, 2024
HSCT for MS: New Updated Results & Approaches 2024, Future Directions 2025+
1. The results of the most effective and safest «R-Flu/Cph» conditioning program (mortality rate 0%, success >80%)
2. New approaches for patients with advanced MS and EDSS > 6.5 – Risks and Benefits of HSCT
- How can we help in case of high disability level?
- How to assess prognosis if I make decision to receive HSCT?
- What is my success rate?
- What should I do if HSCT did not help me? (New approaches for patients who failed HSCT)
3. Future directions and development in treatment of autoimmune diseases 2025+
WEBINAR REcord
December 07, 2023
Treatment of Multiple Sclerosis and other Autoimmune Diseases
Treatment of Multiple Sclerosis and other Autoimmune Diseases
WEBINAR REcord
23 December 2022
WEBINAR
24 November 2021
<<< Gallery >>>
WEBINAR
01 March 2020
Topics of Webinar
HSCT treatment: Established or Experimental?
New approaches for treatment of very rare neurological diseases
Types of HSCT Protocols: Standard, Advanced and Second time treatment.
Treatment of Stiff Person Syndrome (SPS), Chronic inflammatory demyelinating polyneuropathy (CIDP), SSс, Vasculitis and other Rheumatic diseases.
Effectiveness of HSCT for Primary and Secondary Progressive Multiple Sclerosis
Effectiveness of HSCT vs Conventual Medication
Why do doctors around the world first recommend traditional medication treatment?
Does taking a medication thru many years influence the effects or side effects of HSCT
Examination of Non-Core Diseases before HSCT, eligibility criteria.
What is the probability of side effects from treatment and how to prevent them.
What patients would you not recommend treatment for?
Statistics about Patients who developed Avascular Necrosis (AVN) and how to avoid it.
Rehabilitation and Follow-Up after High Dose Immunosuppressive Therapy with Autologous Hematopoietic Stem Cell Transplantation
Artificial fever and other undocumented treatments during rehabilitation.
And other issues related to High Dose Immunosuppressive Therapy with Autologous Hematopoietic Stem Cell Transplantation for patients with Multiple Sclerosis and other Autoimmune Diseases
WEBINAR
19 December 2019
Topics of Webinar
Some Important Issues about Autoimmune Diseases (AID)
Modern Concept of Treatment of AID (Multiple Sclerosis)
About National Medical Surgical Center named after N.I.Pirogov
Rationale for the use of HSCT for Patients with Multiple Sclerosis
Our Expirience: Treatment Outcomes
Open Questions
Summary and Perspectives
Association "New Life"
WEBINAR
15 December 2018
Presenter: MD, PhD, Professor, Dr. Denis Fedorenko
The Leading Hematologist of Russia, Doctor of Medical Sciences, Professor of the Department of Hematology and Cellular Therapy
Assistant: Anastasia Panchenko
The administrator of the Department of Hematology and Cellular Therapy in Medical Surgical Center
Interviewer: Gwen Higgs
Interviewer: Janet Voyce
Interviewer: Ann Wilson
Special thanks for the support to the Facebook society: "Russia HSCT for MS & Autoimmune Diseases"
The Leading Hematologist of Russia, Doctor of Medical Sciences, Professor of the Department of Hematology and Cellular Therapy
Assistant: Anastasia Panchenko
The administrator of the Department of Hematology and Cellular Therapy in Medical Surgical Center
Interviewer: Gwen Higgs
Interviewer: Janet Voyce
Interviewer: Ann Wilson
Special thanks for the support to the Facebook society: "Russia HSCT for MS & Autoimmune Diseases"
WEBINAR
25 June 2018
- InterviewerFounder & Art Director of a Facebook group
Russia HSCT for MS & Autoimmune Diseases
QUESTIONS
Here you can find the answers to questions
that were posted during the event
that were posted during the event
Participant:
Hello Dr. F. Im 24 years old and had a great relapse in august last year. Since then i suffer from shaking hands. Also my whole body is shaking. So here is my question:
How high is the chance of remission after one year post diagnosis?
How high is the chance of remission after one year post diagnosis?
Dr. Denis Fedorenko:
It's about 80-90%
Participant:
I had never had steroids or osteoporosis before HSCT - yet now I have extensive multifocal AVN.
How can that risk not have been increased by HST?
How can that risk not have been increased by HST?
Dr. Denis Fedorenko:
In this situation we can decrease steroid dose to minimal, no additional risk.
Participant:
Why do you accept people with PPMS without active lesions when other centers say they can't help them?
Dr. Denis Fedorenko:
Our effectiveness rate for PPMS is about 60-70%
Participant:
So, after two years post HSCT, one shouldn't expect much benefits, disability reversal?
Dr. Denis Fedorenko:
MS stabilization (when we have stopped it) is also good. Sorry. Sometimes, transplantation is provided late
Participant:
Can I ask a question - If I had a prior lyme disease infection and now I am testing negative for it. Is it best to rid yourself of lyme first then have HSCT?
Dr. Denis Fedorenko:
If you are negative now, you can have transplantation.
Participant:
I want to ask a question. I m one year after the HSCT. I experienced ataxia before the transplant...but now the ataxia in on and off....do you think it is something I have to worry about.
Dr. Denis Fedorenko:
I don't think you need to worry about. I recommend using right rehabilitation
Participant:
Someone asked if breast milk can be helpful in the healing process...since it helpa to develop theimmune system in babies...
Dr. Denis Fedorenko:
We don't have this experience. I can't understand the mechanism, it isn't databased approach.
Participant:
How can you tell if it's progression post HSCT or just the rollercoaster? And how long does it typically last?
Dr. Denis Fedorenko:
We need to assess every case of worsening individually. It's important to provide examination, neurological assessment, MRI. Rollercoaster is about 3 months.
Participant:
If the treatment doesn't work can you still go back on ms drugs like tysabri as my neurologists said it would change the way my body reacts to drugs so tysabri might not work for me anymoew
Dr. Denis Fedorenko:
Yes we can use DMD (Tysabri etc.). AHSCT doesn't change body reaction to it. But, we are developing new approaches for relapse/progression after AHSCT.
Participant:
What feedback does Dr Fedorenko have about the link of AVN's to the large dose of steroids given during HSCT? Does having the large doses of steroids pre HSCT (to calm inflammation relapse) contribute also to the patient AVN's?
Dr. Denis Fedorenko:
We use mild to moderate dose of steroids. If patient didn't have huge dose of steroids and/or osteoporosis before, the risk is very low.
Participant:
What are the risks of having viruses (Epstein Barr, JC virus) and bacteria like borrelia (not proven in Holland by ELISA and Western Blott, but in Germany based on DNA positive) during the chemo or after the chemo? Is this treated beforehand?
Dr. Denis Fedorenko:
We provide tests for infections (viruses, bacteria) before transplantation. If patient has infection, we treat it.
Participant:
Are there any other conditions (not MS related) that could exclude a patient from this treatment such as Heart bypass surgery, COPD, diabetes etc?
Dr. Denis Fedorenko:
Exclusion Criteria
· Any condition that affects normal functions of organs such as heart, kidneys, lung, liver etc. as this would limit your ability to receive high-dose chemotherapy immunosuppressive therapy with AHSCT
· Any active or long term infection caused by viruses, fungi or bacteria
· Uncontrolled diabetes
· A positive test for HIV, Hepatitis B and Hepatitis C
· Life expectancy is severely limited by another illness
· Evidence myelodysplasia or other non-autoimmune cytopenia
· Having received a cytotoxic agent within one month prior to AHSCT
· Pregnancy or at risk of pregnancy, including those unwilling to practice active contraception during the time of therapy
· Psychiatric illness, mental deficiency, or gross cognitive dysfunction
· Unability to give written informed consent in accordance with research ethics board guidelines
· High disability level in MS patients (EDSS>6.5) and/or stable non-active disease during the last 2 years.
· Any condition that affects normal functions of organs such as heart, kidneys, lung, liver etc. as this would limit your ability to receive high-dose chemotherapy immunosuppressive therapy with AHSCT
· Any active or long term infection caused by viruses, fungi or bacteria
· Uncontrolled diabetes
· A positive test for HIV, Hepatitis B and Hepatitis C
· Life expectancy is severely limited by another illness
· Evidence myelodysplasia or other non-autoimmune cytopenia
· Having received a cytotoxic agent within one month prior to AHSCT
· Pregnancy or at risk of pregnancy, including those unwilling to practice active contraception during the time of therapy
· Psychiatric illness, mental deficiency, or gross cognitive dysfunction
· Unability to give written informed consent in accordance with research ethics board guidelines
· High disability level in MS patients (EDSS>6.5) and/or stable non-active disease during the last 2 years.
Participant:
Dr Federenko will you be doing any investment in the study of remyelination therapy
Dr. Denis Fedorenko:
We are going to take part in research of remyelinating therapy. Maybe, in nearest future.
Participant:
Hello. I wonder if there are long waiting lists for the hsct treatment now? - Camilla
Dr. Denis Fedorenko:
Waiting list is about 6 months, but you should take into account the factor that patient should stop taking immunomodulating drugs in 3-6 months before admission. You can learn more about it in our book.
Participant:
Hello, I was given a working diagnosis of PPMS in August 2016. I have been trying to get HSCT in the UK. I think to get rid of me the review board have suggested I could have Neurosarcoidosis, despite 2 Neurologists still saying MS. What scans/test results will you require in order to consider me for treatment? There might be a plan to give me Rituximab or Cyclophosphamide. If I was approved for AHSCT by you would I need a period of wash out before starting? If so I would refuse these treatments Regards Shaun
Dr. Denis Fedorenko:
It's difficult to make decision about treatment plan distantly.
First of all you need to take a look at HSCT book, and complete our medical questionnaire.
First of all you need to take a look at HSCT book, and complete our medical questionnaire.
Special thanks for the support to all members of the Facebook community:
"Russia HSCT for MS & Autoimmune Diseases"
"Russia HSCT for MS & Autoimmune Diseases"
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