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Haematopoietic Stem Cell Transplantation for Multiple Sclerosis in India

Overview

Worldwide, there are millions of people who are being affected by a massive array of Neurological Diseases. Much to the surprise, there are more than 600 types of Neurological ailments, which affects the Central Nervous System – illnesses like Parkinson’s Disease, Brain Tumours, Epilepsy, Multiple Sclerosis and many others. These ailments need very specialised forms of treatment to ensure an enhanced quality of life for the patients. Among the many treatment methods, Stem Cell Transplant like Hematopoietic Stem Cell Transplantation(HSCT) for Multiple Sclerosis Treatment is one of the most exceptional and cutting edge one.

One of the diseases for which HSCT has proved immensely rewarding is Multiple Sclerosis (MS). It has emerged out to be a very promising treatment for this ailment. Haematopoietic Stem Cell Transplantation (HSCT) is an intense chemotherapy treatment option for patients with multiple sclerosis. This treatment works by stopping the damage that the ailment causes. Haematopoietic Stem Cell Transplantation wipes out and then helps by boosting the regrowth of the damaged immune system, with the help of the patient’s stem cells.

In short, HSCT resets the immune system so that it doesn’t attack the Central Nervous System. Further, the treatment reconstructs the immune system by using a kind of stem cell present in the Bone Marrow. These stem cells are known as Haematopoietic Stem Cells. These stem cells are beneficial as these can produce the various cells in the blood, including immune cells.

What is Multiple Sclerosis?

Multiple sclerosis (MS) is an autoimmune ailment, which affects people while they are in their most productive years. The disease causes irreversible damage, and the level of disability keeps accumulating. It is a long-lasting disorder that affects the spinal cord, brain, and the optic nerve including the overall Central Nervous System (CNS). An immune-mediated ailment, in this the system that is designed to protect and keep the body healthy, strikes some parts of the body that are incredibly crucial in our everyday lives. Hematopoietic Stem Cell Transplantation for Multiple Sclerosis Treatment in India slows down the progression of the disease.

Causes

The exact cause of MS is still unknown. It is an autoimmune disease and in this the body’s immune system attacks its own tissues. In MS, this immune system malfunction attacks and destroys Myelin, which is the fatty matter that coats and prevents the nerve fibres in the Spinal Cord and the Brain. Myelin is like the insulation coating om the electric wires. When this covering is damaged, the nerve fibre gets exposed because of which the messages that travelling through these nerves can slow down or get blocked.

It is not really clear why MS affects some people and not others, but a combination of environmental and genetic factors can play a significant role. The causes include:

• Age – MS can occur at any age, however, most commonly the ailment attacks people belonging to the age group of 15-60
• Sex – Women are twice more vulnerable to developing MS, as compared to men
• Family history – If one of the parents or siblings has had a history of MS, then this person is at a higher risk of developing this ailment
• Certain infections – Different types of viruses have been linked to MS. These include Epstein-Barr, it is the virus that causes infectious Mononucleosis
• Race – White people, specifically, those of Northern European descent, are more vulnerable to getting MS. People of Asian, Native American or African descent are not much at risk
• Climate – MS is a highly prevalent in nations having temperate climates
• Certain autoimmune disorders – If a person has Thyroid problem, inflammatory disease or Type 1 Diabetes, then he or she is at a little higher risk of getting MS
• Smoking – As compared to non-smokers, people who smoke and experience the initial symptoms that may indicate MS,they are more likely to experience a second event,which confirms relapsing-remitting MS

Symptoms of Multiple Sclerosis

Multiple Sclerosis can bring different types of symptoms affecting various areas of the body. At the same time, the symptoms may vary the intensity. Some patients may experience fatigue and numbness, whereas, severe cases of Multiple Sclerosis can cause loss of vision, paralysis, and degenerated Brain function. Stem cell transplant could replace cells damaged by the disease, and all the symptoms could be reversed back to normal.

There are some common and early signs of Multiple Sclerosis, which can be resolved by Hematopoietic Stem Cell Transplantation include:

• Vision issues – Blurred or double vision, even loss of vision
• Tingling sensation and numbness – Usually, paralysis in the arms, legs, face and fingers
• Pains and spasms – Muscle stiffness, uncontrollable and painful jerking movement; most affected are the legs
• Weakness or fatigue – When nerves degenerate in the Spinal Column, the patient suffers chronic fatigue; the defect is noticed first in the legs
• Cognitive problems–Most of the patient with Multiple Sclerosis develop some or the other kind of cognitive issues such as:
  • Issues with memory
  • The shortened span of attention
  • Language issues
  • The difficulty is staying organised
• Balance problems – These may be issues related to the patient’s gait. The patient may often feel lightheaded
• Emotional issues – Depression and other psychological problems are also usual with such patients; moreover, irritability, mood swings. The patient might also suffer from a condition called Pseudobulbar Affect, in which there are bouts of uncontrollable laughing and crying
• Dizziness – Dizziness and issues with balance can hamper the mobility of the patients
• Bladder problems – More than 80 percent of patients with Multiple Sclerosis suffer from a dysfunctional bladder. This includes frequent urination, inability to hold urine or intense urges to urinate
• Sexual Dysfunction – The patient may face issues with sexual arousal or erection issues as these feelings are linked with the Central Nervous System

Additional to these, there can be uncontrollable shaking, slurred speech, and trouble in swallowing, seizures, and loss of hearing. Furthermore, the patient also faces difficulty in coping up with relationships, which makes it further challenging

Stem Cell Transplantation Success Story

Lisa Paulsen, USA

"I am a stomach cancer survivor and this was my second time battling a cancer which required stem cell transplantation, and I knew I wouldn’t go to any other hospital for treatment other than the one where I have been treated before. The care and warmth I received from the nurses and clinical staff of the hospital throughout my procedure has been really amazing. I have always believed that universe has a plan for me and I am sure that a part of its plan was to put me in the care of the professional and fine hands of the surgeons in the hospital in India. I feel happy that all the cancer from my body is removed."

How is Multiple Sclerosis diagnosed?

Usually, a Neurologist is someone who handle the cases of this ailment. The Multiple Sclerosis is diagnosis is done by ruling out other health conditions that might show similar symptoms like in Multiple Sclerosis. First, a thorough evaluation of the patient’s medical history is done a then the doctor may recommend the following tests to reach the final conclusion:

• Blood tests
• Lumbar Puncture – In this, a little sample of fluid is taken from the patient’s Spinal Column and then this is for laboratory analysis. This sample can show abnormalities in the antibodies that are linked with Multiple Sclerosis. It also rules out other health conditions or infections which have symptoms like Multiple Sclerosis
• MRI (Magnetic Resonance Imaging) – This reveals the sections of MS lesions on the patient’s Spinal Cord and Brain. The patient may be administered an intravenous injection with a contrast material, which will highlight the lesions that show that the ailment is in an active phase
• Evokes Potential Tests – These tests record the electrical signals produced by the nervous system in response to stimuli. A visual or electrical stimulusis used, where the patient sees a moving visual pattern, or quick electrical impulses are applied to the nerves in the arms or legs. The electrodes measure how quickly the resulting information goes down the nerve pathways

For most patients, detecting MS is not so difficult and is quite straightforward owing to the pattern of symptoms shown that are consistent with the ailments. Diagnosis MS is more challenging in patients displaying unusual symptoms or progressive disorder. For such patients, additional imaging tests, evoked potential tests, spinal fluid analysis are recommended.

Possible Treatment Options

There is no exact cure for MS. Whatever medications and treatment options for multiple sclerosis are there; they are primarily focused on boosting the recovery from attacks, delaying the progression of the ailment, and managing the symptoms. There are many patients who do not show very mild symptoms and so no treatment is needed. Such patients benefit from family support and lifestyle changes.

However, there are patients, who have a highly active relapsing MS, which means that despite taking all the possible disease-modifying therapies, they are still facing relapses. Haematopoietic Stem Cell Transplantation for MS in India can be extremely fruitful for such patients.

Evaluation Tests before HSCT

During the pre-transplant evaluation phase, there are a lot of medical tests that are done so that the doctor can find out all aspects of the patient’s overall health condition. With these tests, the surgeon and his/her team can find out about the potential issues that may crop before or after the procedure.

• Blood tests
  • Tissue Typing done only for Allogenic patients – a series of blood tests done to check the compatibility between the organ donor and recipient
• With the other blood tests, screening is done for infectious diseases such as:
  • HIV (Human Immunodeficiency Virus)
  • Hepatitis
  • RPR (syphilis)
  • Varicella Zoster
  • Toxoplasmosis
  • HSV (Herpes Simplex virus)
  • CMV (Cytomegalovirus)
  • West Nile Virus
  • EBV (Epstein-Barr virus)
  • HTLV1/11 (Human T-Cell
  • Chagas
  • Lymphotropic virus)
• Blood tests are also done to check the patient’s organ function:
  • Ferritin
  • Complete Metabolic Panel
  • Pregnancy test
  • ABO blood type
  • Haemoglobin solubility
  • Bleeding times
  • Quantitative immunoglobulins
  • CBC, diff, platelets
• Other possible blood work can be:
  • Disease-specific labs for multiple myeloma
  • Research samples
• Other tests
  • Chest X-ray – It provides a picture of Heart and Lungs including information about the size of the Heart and the Lungs. This might also detect the presence of any Lung ailment or infection
  • Pulmonary function tests (PFTs, lung tests) – Pulmonary function tests tell the capacity and function of the Lungs, and blood’s capability to carry oxygen. During these tests, the patient is asked to breathe into an instrument known as a Spirometer
  • There are some guidelines to follow before the planned Pulmonary function tests:
    • The patient must get sufficient amount of sleep the night before the tests
    • Must wear loose clothing during these tests
    • Must limit the intake of liquids and have a light meal prior to the test. This is because eating or drinking too much before the test can make the patient feel bloated and there might be breathing difficulties
  • Computed Tomography scan (CT Scan) – A CT scan uses X-rays and computers to give a thorough image of the body. Depending on the kind of scan required, an oral and/or IV contrast material might be used. With this, the Radiologist can see the extent of the ailment. CT scans also reveal the presence of any other abnormalities.
    • If the patient has had CT scan within six prior to the months before the pre-transplant evaluation, the patient must bring the CT scan films or disc, as well as the previous reports. Then the Radiologist does a comparison between the old and new findings
    • Depending on the disease, the patient might be suggested more CT scans
  • Positron Emission Tomography (PET) scan – This is a specific type of imaging test, which helps doctors to see how the organs and tissues inside the patient’s body are actually functioning
  • The test involves injecting a small dose of radioactive chemical, known as radiotracer, into a vein. The tracer travels through the body and is absorbed by the tissues and organs being studied. Next, the patient is asked to lie down on an examination table, which is then moved into the centre of a PET scanner – a doughnut-like shaped machine. It detects and records the energy given by the tracer substance. Further, the PET scan can measure vital function like glucose metabolism. This helps the doctors to identify abnormal from normally functioning tissues and organs.
  • One of the key differences between PET scans and other imaging tests like CT scan or Magnetic Resonance Imaging (MRI) is that, the PET scan shows the cellular level metabolism changes happening in a tissue or an organ, or the activity of cells
• Heart tests – Because prior Chemotherapy and/or Radiation Therapy and the Chemotherapy/ Radiation Therapy, which the patient receives for transplant can damage the Heart, it is important that the patient goes through Heart tests to find out and address any potential problems, prior to the transplant procedure. The Heart tests include:
  • Electrocardiogram (EKG): This is helpful in evaluating the Heart’s rhythm. Before the test, electrodes (flat, small, sticky patches) are placed on the patient’s chest. These electrodes are attached to an Electrocardiograph monitor, which records the Heart’s electrical activity
  • Echocardiogram: An Echocardiogram is a graphic outline of the Heart’s movement. During the test, a wand, or a transduceris positioned on the Chest. The transducer emits ultrasound that is highfrequency sound wave, vibrations. This way the doctor can see the outline of the Heart’s movement. The Echocardiogram provides pictures of the Heart’s chambers and valves, so that the pumping action of the heart can be assessed. Echocardiogram is many times combined with Doppler Ultrasound to evaluate the blood flow across the Heart’s valves
  • Bone Marrow Biopsy –This is done to evaluate the patient’s marrow’s function. A needle is placed in the posterior hip bone to take out a sample of Bone Marrow. The specific area is numbed with a local anaesthetic, or a pain-relieving medicine, to make the patient feel comfortable.
• Skeletal Survey
  • This is a series of X-rays of the skull and long bones to evaluate the ailment involvement for patients suffering from Multiple Myeloma

How is Haematopoietic Stem Cell Transplantation done?

A patient for whom this method of treatment has been finalized, will be thoroughly evaluated like mentioned above. The process begins by giving medication to patient that will encourage the Haematopoietic Stem Cells to move out of the Bone Marrow into the blood. This is a trying time for the patient because the symptoms of MS worsen during this phase. After about 10 days, when there is sufficient quantity of stem cells in the patient’s blood, they are taken and stored for using later during the treatment process.

After this, Chemotherapy is given as an infusion to wipe out the patient’s immune system. This phase can take many days. Chemotherapy can be either Myeloablative, which totally wipes out the immune system), or it can be Non-myeloablative that is wiping out the immune system partially.

Once this is done, the stored stem cells are transplanted back in the patient’s body via a drip. Once these cells are in the body, they start working on rebuilding the immune system. This can take a couple of days post-chemotherapy, till the drugs have cleared the patient’s system.

Within a span of 10-30 days, the stem cells start creating new blood and immune cells. Since the patient’s immune system is not functioning at this time, he or she can be very prone to getting infections. Owing to this reason, the patient is given appropriate medications and put on transfusion to help.

While the patient is experiencing this phase, he or she to spend approximately a month in isolation to avoid getting kind of infection as their immune system is under construction. This phase of treatment can be very lonely and challenging for the patient.

Benefits of HSCT

An extensive amount of research has and is being done on this treatment technique and the results have been very encouraging. This treatment is considered a very safe and remarkably advantageous procedure for patients with MS.

• It can very ably lower the chances of relapses, primarily for patients with Relapsing MS
• The patient feels more stable and
• The quality of life is enhanced as compared to what it was before the treatment
• It also slows down the clinical progression of the ailment.

Any Risks?

Undoubtedly, HSCT is a massively rewarding treatment technique, but at the same time, it is quite aggressive too. It comes with some short-term as well as long-term risks and complications. These can be:

• An increased and long-term risk of getting infections
• Risk of getting Cancer and autoimmune conditions like Thyroiditis
• Early menopause
• Nausea (short-term)
• Vomiting (short-term)
• Fertility issues

Then there is Chemotherapy, which has its own set of risks, including:

• Bleeding
• Bruising
• Hair loss
• Loss of appetite
• Rare but there are some chances of worsened Neurological function and losing mobility

Despite these associated risks, the final outcome is definitely making it worth for the patients, which is more and more patients MS are being recommended this form of treatment. HSCT has given a huge ray of hope countless patients with MS, across the globe.

While at Home

For a Neurological disorder like MS, the symptoms are the most burdening factor. Although, medications and other forms of treatment are there to help the patient cope up with the symptoms, but there is a lot that can be done at the home front to, such as:

• It is advisable to take sufficient amount of rest
• Relieving stress – The stress associated with this ailment is very high so for getting some relief from the same may indulge in Yoga, massage, meditation, Tai Chi, etc. This is crucial because many times, stress can aggravate the signs and symptoms
• Cooling down –The symptoms of MS very often worsen, when the patient’s body temperature rises. So, it is advisable that the patient avoids exposure to heat and may also use devices like cooling vest or scarves
• Exercise –If the ailment is in mild to moderate stage, then regular exercise can be helpful. It can enhance the patient’s strength, balance and coordination, muscle tone, etc. If bothered by heat, then swimming or other water-related exercises are also good options. Other forms of exercise can be slow walking, stretching, stationary bicycling, and low-impact aerobics
• A balanced diet –A healthy and balanced is something that always has it own rewards. Likewise, research results show that for patients suffering from MS, a diet with low amount of saturated fats but high in Omega-3 fatty acids like fish oil and olive oil. Additionally, there is research that shows that Vitamin D may also have positive effect on such patients
• Love and support from family and friends matter a lot. The patient must try to stay involved in routine activities as much as possible. Pursuing a hobby can also prove beneficial

Why India can be the Best Destination for HSCT?

Each and every sector in India is extremely established for India is appreciated across the world. It is more specifically, the field of healthcare, for which, with every passing year, India is becoming more and more popular and is respected. The all-embracing treatment facilities that India offers are drawing the attention of countless patients from different corners of the globe. Further, with the advent of Medical Tourism it has further easy for these patients to visit India avail the required treatment.

So, what exactly are the features that attract these medical tourists? First and foremost is the welcoming ambience of India, where patients belonging to any race, any culture, or any economic class and irrespective of any language differences. The patients feel at home despite being outside the boundaries of their countries.

Next are the hospitals, which are setting the standards higher with passing time. The hospitals in India are giving a tough fight to the hospitals in other leading countries. With a very safe and hygienic atmosphere, the patients can be assured that they are totally away from any infections and complications. Every kind of latest treatment is available here – latest treatment amenities, surgical approaches, highly efficient and trained nursing staff and much more. Some of the hospitals that can be perfect for HSCT, are:

• BLK Super Specialty Hospital, Delhi
• Jaslok Hospital & Research Centre, Mumbai
• Fortis Memorial Hospital, Gurgaon
• Narayana Health, Bengaluru
• Max Healthcare Hospital, Delhi
• Nanavati Hospital, Mumbai
• Ruby Hall Cancer Centre, Pune
• KokilabenDhirubhai Ambani Hospital
• Rajiv Gandhi Cancer Institute and Research Centre, Delhi

These and many more such hospitals have become highly preferred treatment destinations owing to the doctors and surgeons working here. Even the most intricate procedures are handled very fluently by these surgeons. When it comes to HSCT, these surgeons are extremely knowledgeable and proficient. With extensive learning and experience in this, these Stem Cell Transplantation specialists are taking the success rates of this procedure higher and higher. The patients are in extremely safe hands, when choosing to get treatment done by these renowned HSCT experts. Some of these experts are:

• Dr.Rahul Bhargava
• Dr. Vikas Dua
• Dr. Aniruddha Dayama
• Dr. Roshan Dixit
• Dr. Nitin Sood
• Dr. Neha Rastogi
• Dr. Ashok Kumar Vaid
• Dr. Amit Rauthan
• Dr. Ashish Dixit
• Dr. Sameer A. Tulpule

The patients might assume that availing the progressive treatment services as well the services of these above mentioned surgeons can be very burdening. However, as compared to other countries, India offers huge cost benefits, even if its as progressive a treatment like HSCT.Overall, getting treatment in India becomes a very happy and wholesome experience for the patients. Finally, to get all these commendable healthcare services, the patients can choose to plan their visit to India with the outstanding medical tour planner in India.