Should autologous hematopoietic stem cell transplantation be offered as a first-line disease modifying therapy to patients with multiple sclerosis?

Description: The available evidence on the potential role of AHSCT as first-line treatment in aggressive MS and the rationale for its early use will be summarized. Proposed definitions of aggressive MS that could help identifying MS patients eligible for early treatment with AHSCT will also be
discussed.

Outcomes: The improvement of the safety profile of AHSCT in MS has already allowed increasing anticipation of its use in recent years compared to older studies, which included mostly patients with advanced disease and reported poor outcomes. Nonetheless, prior failure of available DMTs remains a requirement for eligibility for AHSCT in most protocols, possibly resulting in a late referral of patients who have failed multiple treatments and who have acquired a burden of CNS pathology and clinical disability in the meantime. To optimally treat patients with highly active disease, AHSCT has recently been explored as a first-line treatment.