A NEW single centre cohort study has demonstrated that autologous haematopoietic stem cell transplantation (AHSCT) has superior efficacy in reducing relapses and MRI activity compared to alemtuzumab (ATZ) and ocrelizumab (OCR) in patients with relapsing multiple sclerosis, while disability progression rates were similar across all treatments.
This study aimed to compare the clinical and radiological outcomes of AHSCT, ATZ, and OCR in relapsing–remitting multiple sclerosis. Data were collected from 621 patients at a London hospital, with 103 receiving AHSCT, 204 treated with ATZ, and 314 with OCR. The median follow-up periods were 43 months for both AHSCT and ATZ, and 32 months for OCR. Outcomes measured included annualised relapse rate, new MRI lesions, and disability progression using the Expanded Disability Status Scale (EDSS).
The results showed that AHSCT was associated with a significantly lower mean annualised relapse rate after five years compared to ATZ (0.026 vs 0.087; p < 0.001), and a reduced risk of relapses (hazard ratio [HR] 0.29, 95% CI 0.13–0.63; p = 0.002) and MRI activity (HR 0.33, 95% CI 0.15–0.72; p = 0.006). Compared to OCR, after three years, AHSCT also resulted in a lower annualised relapse rate (0.028 vs 0.073; p = 0.02) and a trend towards reduced relapse risk (HR 0.45, 95% CI 0.18–1.14; p = 0.09), with similar rates of new MRI activity (6%; HR 0.86, 95% CI 0.28–2.67; p = 0.80). Disability progression risk was comparable between AHSCT and both ATZ (HR 1.19, 95% CI 0.71–2.00; p = 0.50) and OCR (HR 1.08, 95% CI 0.57–2.04; p = 0.82).
In conclusion, AHSCT provided greater suppression of relapses and MRI activity than ATZ, and similar MRI outcomes to OCR, although follow-up was shorter for OCR. The comparable disability progression across all treatments suggests that while AHSCT may offer superior disease activity control, its impact on long-term disability remains similar.
Reference
Muraro PA et al. Effectiveness of autologous hematopoietic stem cell transplantation versus alemtuzumab and ocrelizumab in relapsing multiple sclerosis: a single center cohort study. Annals of Neurology. 2025;DOI:10.1002/ana.27247.
