Wants more people to benefit from an effective MS treatment

Joachim Burman in front of a computer that shows PET scans of the brain.

Chief physician Joachim Burman hopes that more MS patients will receive autologous blood transplants – a treatment that in the majority of cases leads to great improvement in their symptoms. Photo: Tobias Sterner/BILDBYRÅN

It’s no more dangerous than hip replacement surgery. This is how senior consultant Joachim Burman describes the autologous blood transplant that can probably cure multiple sclerosis (MS). His new study shows that the method is safe, can be done as part of ordinary healthcare and that it gives people with MS the opportunity to live a drug-free life.

The study, which was published the day before our interview, has been picked up by a number of international media outlets. Joachim Burman is glad that it’s getting this level of attention, and hopes that it can pave the way for more MS patients to receive treatment with an autologous blood transplant.

“The study shows that it is a safe treatment and effective for a very long time, perhaps even for life. We can also see that in Sweden it can be done safely, even as part of ordinary healthcare, which is very important if we are going to treat many people,” says Joachim Burman, chief physician at Uppsala’s University Hospital and docent at Uppsala University.

In 2004, the first autologous blood transplant was carried out at Uppsala’s University Hospital. The method involves extracting the patient’s own blood stem cells and then knocking out the immune system that is the bearer of MS with the aid of chemotherapy. After that, the immune system is restored again by returning the patient’s own stem cells.

The study followed 174 patients who had received this treatment up until 2020. It could be seen that as many as 89 per cent of these individuals were able to manage without other treatment after receiving the transplant.

“Not needing other drugs – that’s a feeling of freedom. They no longer bear the yoke of having to go to a clinic for treatment, but can live a normal life without thinking about MS.

In more than half the patients, their symptoms improved. The patient who was followed for the longest time had survived 16 years without a relapse of the disease.

Why don’t all people with MS get autologous blood transplants?

Autologous blood transplants are best suited for patients with aggressive MS who have been diagnosed at an early stage. The treatment itself is also demanding for the individual.

“The treatment takes about a month and a half, so the patient needs to be in and out of hospital during that period of time. Then you are on sick leave for three months. Many people feel rotten during the treatment. Chemotherapy can cause hair loss for example. You have to put your life on hold for six months."

For women, there is also an increased risk of early menopause which is not appropriate for those who want to have children. People with mild MS often get by with disease modifying therapies and can live a good life.

Joachim Burman holds a test tube rack in his hands in front of a machine that analyses blood samples.

In the lab, analyses of the patients’ blood samples are performed. Neurofilaments are a type of protein polymer that Joachim Burman likens to the nerve cell's steel reinforcement, and when found in the blood may indicate that the patient has active MS. Photo: Tobias Sterner/BILDBYRÅN

Important to detect before the disease goes too far

Unfortunately, there are also patients where MS has progressed too far to respond well to the transplant treatment. MS breaks down nerve fibres, which, among other things, causes the brain to shrink. It is estimated that the volume of the brain decreases by one to two per cent per year. In some cases, the disease has progressed so far that only 70 per cent of the brain remains. In these cases, the nerve fibres are so damaged that we cannot be certain that an autologous blood transplant will have any benefit.

To find ways to help these patients, Joachim Burman wants to investigate another type of treatment using exosomes from mesenchymal stem cells. In animal studies, it has been found that treatment with exosomes can regenerate damaged tissue in the brain, which is the problem with very advanced MS.

“We can manufacture exosomes in the lab today and we’re ready to start trials with patients. It works in theory, but isn’t currently an established method and there is a long way to go. But we have high hopes."

For patients whose brains are not as damaged, it has been found that an autologous blood transplant can lead to stabilisation of disease progression, and that the brain actually recovers.

Joachim Burman stands in the lab in front of a refrigerator.

Today, two different MS treatments are usually trialled before an autologous blood transplant is considered. Joachim Burman’s view is that a transplant should be proposed after it has become apparent that the first treatment trialled did not seem to work. Photo: Tobias Sterner/BILDBYRÅN

Wants to see the treatment used more widely

Joachim Burman says that autologous blood transplants have been seen as a procedure with too high a risk for a non-fatal disease such as MS. The study presented now shows that the treatment is not actually riskier than many other interventions that are done in healthcare today.

“Doing this is about as dangerous as hip replacement surgery if done in the way we do it today.”

He estimates that around 10 per cent of the 1000 patients diagnosed with MS annually would be helped by a transplant. That is many more people than receive this treatment today. Just before the pandemic, 35 were carried out each year. This treatment can also be economically advantageous. A transplant costs the healthcare system around SEK 600,000. Conventional MS treatment costs between SEK 80,000 to SEK 250,000 per year.

“The costs of an autologous blood transplant are mainly associated with the fact that it is expensive to be in hospital. But the money goes mainly to the salaries of the nurses there. For other treatments, the money goes to pharmaceutical companies.”

The big challenge is to identify patients who could respond well to the treatment before their disease has progressed too far. Studies are in progress on how to identify early signs that the nerve fibres are breaking down, even before the patient begins to develop clear symptoms. Among other things, by looking for small markers in the blood, substances that are released when nerve cells die.

For Joachim Burman, this work is going on in parallel with trying to spread the word about the good results they have been able to see for autologous blood transplants in Sweden.

“I have met many of these patients and followed them. The impact that this can have on people’s lives is the reason we keep going. We know that it worked really well for these people, so there ought to be more people who can benefit from this treatment. That’s something you can’t keep quiet about.”

Sandra Gunnarsson

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