Abstract:
Introduction. Autologous hematopoietic stem cell transplantation (AHSCT) is a therapeutic strategy
with curative potential for relapsing-remitting multiple sclerosis (RRMS) [1]. AHSCT is a modern
alternative to disease-modifying therapies, since a low therapeutic response has been observed in
RRMS patients [6]. The action mechanism is based on the immunosuppression of autoreactive
lymphocytes to subsequently remodel the immune response through self-hematopoietic stem cells [1,
3], restoring immune tolerance and suppressing the inflammatory response [2].
Materials and methods. For this study, was performed a search of the specialized scientific literature
from 2019-2025, the articles were identified through the search engine PubMed, Google Scholar.
Results. A prevalence of 68%-88% of patients undergoing AHSCT maintained no evidence of disease
activity: NEDA-3 (no relapses, no magnetic resonance imaging activity and no MS progression) in the
following 3-5 years after therapy [4, 8]. The efficacy rate is 86.9-91.3% due to the absence of clinical
relapses at 5 years after transplantation [1, 2]. The success rate is higher in patients under 45-50, with
an expanded disability status scale (EDSS) <5.5-6 [4], and disease duration of less than 5-10 years,
thus having a higher chance of remission [1]. The mortality is 2.1% [2]. To confirm the biological
efficacy, cerebrospinal fluid is extracted, and it has been observed that CXCL13 decreases in the first
year and sCD27 normalizes over the next two years [6]. Complications vary depending on individual
tolerance and 17% of patients suffer from Uhthoff's phenomenon in the first 60 days [4],
myelosuppression in the first 100 days [7], neutropenia (58%-70%) [8], bacterial sepsis, pneumonia,
urinary tract infections, hemorrhagic cystitis, dyspeptic disorders and venous thrombosis [4].
Autoimmune thyroiditis or immune thrombocytopenia occur in 4-6%, Epstein-Barr virus and
cytomegalovirus are reactivated in 80% of cases, and there have been recorded oncological risks such
as breast cancer, glioblastoma, prostate cancer post-AHSCT [4]. Arrhythmias, renal failure and
infertility are found in a minor percentage [5, 7].
Conclusions. With over 80% efficacy, AHSCT is the most effective treatment for RRMS, and despite
adverse reactions, this therapy offers optimal therapeutic prospects for patients with active forms of
MS.
