Episode 43

A conversation about MS and AHSCT: Autologous Haematopoietic Stem Cell Transplant

On this episode of The Raw Nerve, host Dr Julia Morahan, Head of Research at MS Australia is joined by retired police officer, Michael Butler who lives with multiple sclerosis (MS), and his neurologist, Dr Jennifer Massey from St Vincent’s Hospital, New South Wales, for an in-depth conversation about Autologous Haematopoietic Stem Cell Transplant (AHSCT) and MS.

This episode is for those who want to understand more about AHSCT from an expert and hear from someone who has had the treatment in Australia.

Michael Butler has lived with MS for over 20 years and shares his incredible 2002 diagnosis story while a serving officer in the New South Wales police force. He talks through his subsequent MS journey and personal mantra for making the most of what you can rather than can’t do. Michael and his neurologist talk about his referral to Dr Massey’s clinic at St Vincent’s, his early days as a patient, treatment history and AHSCT journey.

Host Dr Julia Morahan explains AHSCT and provides insight into MS Australia’s involvement in AHSCT research nationally and internationally and registry of people that have been receiving this treatment in Australia – headquartered at St Vincent’s in Sydney – where MS Australia tracks the outcomes of Australians who have undergone this treatment for MS.

Detailing her considerations around presenting AHSCT as a treatment for those eligible while explaining the risks, Dr Massey says, “a big part of this treatment is about identifying people who are most likely to benefit, and that’s where accumulating information and these registry studies are going to be most beneficial.” She shares advice for others considering AHSCT, especially the factors to weigh up if they are thinking of making this decision. And given the abundance of media about stem cells across a range of neurological conditions, not just MS, Dr Massey thinks, “having a good understanding of what this treatment is, what it can offer, what it can’t offer, and the risks are really the key.”

Michael generously talks through and shares for listeners his decision to try the treatment and his preparation, journey, support networks and his life today.

Key Topics

  • The lived experience
  • Health management
  • Consultation process

Useful Links

Currently AHSCT treatment is provided in Australia at St Vincent’s, Sydney and through two observational clinical trials at Austin Health, Melbourne and The Alfred, Melbourne (visit the MS Australia Clinical Trials Network website for more information) and by a small number of other centres on a case by case basis. These centres have strict eligibility requirements that have been set by the hospital ethics committees and may only apply to limited numbers of patients with MS. It is for this reason patients need to be referred to these centres by a neurologist, who can provide a detailed clinical history and MRI findings.

Acronym Glossary

  • MS – multiple sclerosis
  • AHSCT – Autologous Haematopoietic Stem Cell Transplant (sometimes referred to as HSCT)
  • MRI – magnetic resonance imaging
  • PIRA – progression independent of relapse activity

Episode Transcript

Voiceover: 

Welcome to The Raw Nerve, the official podcast of MS Australia, a conversation space for all things multiple sclerosis. Join us for news and views on the latest research, treatments, and advocacy efforts, as well as candid and informative interviews with our community, those living with MS and their families and carers, together with leading clinicians, researchers, and advocates. 

Julia Morahan: 

Welcome to The Raw Nerve where we delve deep into the realities of living with multiple sclerosis or MS for short. 

I’m Dr Julia Morahan, Head of Research at MS Australia, and today we have an important conversation lined up for you. 

We’re joined by Michael Butler, a former police officer living with MS, and Dr Jennifer Massey, his neurologist who specialises in the treatment of MS. 

Welcome Michael and Jennifer. 

Michael let’s start with you. Can you share a bit about your journey with MS and how you came to be diagnosed? 

Michael Butler: 

Thank you for having me. 

I was diagnosed with MS back in 2002, so what’s that? 20 something years ago. 

My first symptom was optic neuritis and that happened while I was actually at work and from there, it was a long-drawn-out experience to get diagnosed properly. But yeah, so that’s how it happened to me. My first symptom was optic neuritis. 

Julia Morahan: 

Managing a chronic condition like MS while pursuing a demanding career in the police force must have been challenging. Could you tell us a little bit about how you managed your health and maintained balance and maybe something about the initial challenges you faced? 

Michael Butler: 

Yep. So I was originally diagnosed back in 2002. The way which it all happened; I was actually working in the police at the time. I was working in the crime scene unit, so I was fingerprinting a car, and all was good. I found a fingerprint and labelled it, went to photograph it, got the camera out, put the camera up against the fingerprint, and all of a sudden it was gone, and I had no explanation for it. I thought I must’ve had a smudge on the lens, couldn’t see anything there. So it was a complete mystery as to what had happened. 

Yeah, in that instant second is where I got MS. There was no warning for it, no build-up, just in a split second I couldn’t see out of my right eye. And taking a photograph, I used my right eye to be able to focus in on it and it just disappeared. So I thought something’s not right. 

From there, ended up finishing it by using my left eye, I could see clearly, so that’s when I realised there was something actually wrong with my right eye, but had no explanation for it because I hadn’t… Like I said, there was no build-up to it and it was a complete mystery as to what had happened. It just went very foggy and blurry in my right eye. 

Julia Morahan: 

Yeah, it must have been very frightening. 

Michael Butler: 

Yeah, just confusing. 

Julia Morahan: 

And then after that, after your diagnosis, how did you go with living with MS and balancing your job and your life with your symptoms? 

Michael Butler: 

After being diagnosed, the big thing there is to try and make a plan. Unfortunately, this is the older self talking to my younger self here is back then I didn’t have that same attitude. It was more like, “Let’s just get on with life and carry on as normal.” As an older person, I look back and wish I could have spoken to that person and try and make a plan. 

And when it comes to work, it’s simple things like, “What can I do rather than what can’t I do? What’s going to allow me to move forward in the future?” Just changing the type of job that you do. So that’s what I had to do in the police. 

Julia Morahan: 

Yeah, that’s great advice. Yeah, I think that would be really nice for some of our listeners to hear about making a plan about what you can do rather than what you can’t do and trying to plan with the MS and make the most of the situation that you’re in. 

Michael Butler: 

Yeah, absolutely. 

I had to… You then focus on, okay, is the future going to hold that I can’t walk properly, run properly, stuff like that. So what can I do rather than chasing after crooks?  

Julia Morahan: 

Yeah, it’s a good attitude. 

All right, so Jennifer, can you please share how you were involved in Michael’s journey when it came to presenting different treatment options? 

Michael’s been diagnosed and now we’re thinking about what can we do about it from a neurological perspective, right? 

Jennifer Massey: 

Yeah. Thanks, Julia. Thanks for having me on this podcast. 

So, I actually first met Michael in 2017, so it was many, many years obviously into his MS journey and he was referred to our clinic from one of my colleagues who had been looking after Michael for the preceding few years. 

The big question when Michael came to see me was where do we go from here in terms of his immunotherapy. Michael had been, and I’ll let Michael talk to this to the degree that he wants to, but he’d been on some medication and in essence with changes in treatment, there was new inflammatory activities. 

Michael had had new symptoms and new spots on his scan and so he was referred to our AHSCT clinic, and I know we’re going to get into that a bit more in a second, but he was referred to our clinic for consideration of essentially escalation of immunotherapy given that his MS was not being adequately controlled in terms of the relapses despite the medication that he was on at the time. 

Julia Morahan: 

Michael, that’s potentially a big step being referred to the AHSCT clinic and we’ll talk about that in a sec, but just to jump in here and say how did you feel when you were referred to Jennifer’s clinic in terms of you’d had these medications and they maybe weren’t working as well as they could have been? 

Michael Butler: 

I was really grateful for it. I was actually excited, as silly as that might sound, because my journey, going back to when I was diagnosed, my first drug was Copaxone, which was the daily injection, what I call the bee sting every day. And that was horrible. 

From then, I went on to Fingolimod, which was much better because it was just a tablet each day, then tried Tysabri and didn’t seem to have the effect that it needed to because I kept getting lesions. 

So really I had no other option other than probably Ocrevus or HSCT. And when I was given the option, it was a pretty simple decision for me really. 

Julia Morahan: 

I think now might be a good time to just explain a little bit about AHSCT for our listeners, or Autologous Haematopoietic Stem Cell Transplant. It is a treatment that is being used in Australia to treat MS. MS Australia has been involved with some research around this and also a registry of people that have been receiving this treatment in Australia. 

But essentially it is an immunosuppressive chemotherapy treatment, which is combined with a reinfusion of blood stem cells. The idea is that you essentially wipe out the old immune system, which clearly has MS and rebuild a new immune system from the blood stem cells. And the hope is that the new immune system or the rebooted immune system will be less self-reactive and hopefully, no longer continue to attack the body in the same way as the previous immune system I guess. 

It’s important to stress that this type of stem cell treatment does not repair the brain and spinal cord. They’re not neurological stem cells, they’re immune stem cells. So what we’re doing is essentially resetting the immune system. 

So there’s a few steps. First, we have a pre-treatment to release the bone marrow stem cells into the blood and then we harvest those from the blood of the person undergoing the treatment, freeze them in the laboratory, and then administer an immunochemotherapy to remove the person undergoing the treatment’s current immune system, which is known as conditioning, and then return those thawed stem cells back to the person undergoing the treatment by infusion. And then from there, the body will rebuild an immune system as we have said. 

It’s important that there’s supportive medical treatment in the immediate follow-up period where there can be some risks, as you can imagine, while the immune system is rebuilding. 

Also, MS Australia is very happy to contribute to the international efforts to increase our understanding. And I mentioned that we do have the MS AHSCT registry, which has been going since 2011, in fact is headquartered at St. Vincent’s in Sydney where Jennifer works, where we are tracking the outcomes of Australians who have undergone this treatment for MS. 

So there has been a lot of chat, interest, information about risks and benefits of this treatment. Jennifer, can I ask you, as Michael’s neurologist, could you explain when you’re thinking about offering AHSCT as a treatment for somebody. How do you explain those risks? What are those risks, especially for somebody like Michael? 

Jennifer Massey: 

Yeah, absolutely. 

I say this to all of patients referred to our clinic. AHSCT is a pretty heavy-duty intervention and essentially, as you’ve outlined Julia, the effector arm of this treatment is the chemotherapy. So the stem cells allow a more rapid recovery of the immune system but the effective part of the treatment is the chemotherapy knocking out the existing immune system. That’s also the part of the treatment that carries the risks. 

We tend to think of risks of AHSCT in terms of short-term risks, so around the time of the transplant and roughly, the first three months afterwards and then long-term risks. 

As many people would know, chemotherapy lowers your immune system. That’s what we’re aiming for it to do here. So obviously, the biggest risk, both in the short but also in the longer term is the risk of infection. 

That can be infection from the community, viruses, or infections that are brought into the hospital when someone’s in hospital but also infections from bugs on our own body. 

And because of the effect of the chemotherapy on the lining of the gut, the lining of the mouth, the swallowing, you’re at risk of getting pneumonia or blood infections from bugs that live on our skin and in our gut normally. 

In the longer term, the infection risk is more to do with viral infections and really people are considered immune suppressed for roughly the first two years after the transplant. Although every, I suppose, three to six months from the time of the transplant, those risks get less and less. 

The second big issue is risk of organ toxicity or organ damage from the chemotherapy. We can screen people before they have the chemotherapy and try and mitigate any of those risks, but it’s something that we’re still very mindful of. 

In the longer term, there are risks of what we call secondary autoimmunity, which sounds bizarre, but sometimes when you try and reset the immune system, you can trigger other autoimmune conditions, and we think that happens in between sort of three to four per cent of people having this treatment. 

The big one for people with MS is the effect on fertility. Because the chemotherapy that we use is so heavy duty, it can render people essentially prematurely menopausal and reduce fertility. That can be an issue in both men and women. 

The other important thing that we always have to consider is whether this treatment could make someone’s MS worse. So not only are we essentially requiring people to be in hospital essentially in one room, as Michael can tell you, for just under a month when they’re having the treatment itself, but the chemotherapy can also cause effects on brain chemistry and on brain volumes in the short term. 

And so, a big part of this treatment is about identifying people who are most likely to benefit, and that’s where accumulating information and these registry studies are going to be most beneficial. 

Julia Morahan: 

Thanks for that, Jennifer. 

Michael, how did you first come across AHSCT and what led you to consider it as a treatment? 

Michael Butler: 

I first heard about it years before I did it. It was that thing that people spoke about going to Russia or Mexico to do it because it seemed like that was the only two places in the world that were doing it at the time. It cost a lot of money to do it that way. 

Because I was being treated at St. Vincent’s and that’s where the trial was being run, it just all fell into place at the time when I hit a dead end with options for my treatment. So that’s how I came across it to be realistic rather than having to raise a hundred grand to go overseas. 

Julia Morahan: 

I guess Jennifer’s outlined a number of risks there. When you were considering going for AHSCT, how did you weigh up the potential benefits and risks?   

Michael Butler: 

To be totally honest with you, I wasn’t really concerned about the risks to the point where I didn’t even start googling like a lot of people do and try and look at the doom and gloom. I was just trying to look for what was the best option to be able to move forward. 

I didn’t focus on the risks or the negatives. I was just trying to work out how to get myself prepared for this the best I could. That led to different lifestyle changes as well to get myself ready to go in and try this experiment. 

Julia Morahan: 

So a bit of mental and physical preparation for the treatment for you? 

Michael Butler: 

Yeah. For the first time ever, I started going to the gym. I just had a goal of trying to get myself as good as I could before it because I knew it was going to take a toll, and it worked wonders. 

Julia Morahan: 

All right. So you did undergo AHSCT as we know that’s what we’re discussing. Could you maybe describe a little bit for our listeners your experience after the transplant? How did it affect your daily life and your symptoms? 

Michael Butler: 

After the transplant was… As Jen said before, it was more about avoiding infection. I know that’s a very broad thing to say but, yeah, it was simple things like avoiding public transport, going on what was known as the pregnancy diet, trying to eat clean, that sort of thing. 

Rest was a big one. And then silly things like… 

I was lucky to be able to do the treatment at the same time as two other ladies and we all got together as a group and had our own little group chat going on about what to do, what not to do, and just silly things like what can help you grow your hair back quicker and things like that because naturally you end up completely bald from the chemotherapy and just good and bad things that help with the feeling sick, nausea, and all those sort of things. 

But to be honest, the recovery wasn’t too bad. I was actually back at work within three months. 

Julia Morahan: 

I think still a pretty major thing to have happened to a person. So you had your little miniature self-made peer support group with your other two co-treated people, which is actually an amazing idea. How else did you cope with the emotional and psychological aspects? 

Michael Butler: 

Yeah. When you asked me psychologically how I moved on, I feel like, yeah, I just got on with things and I wasn’t focusing on the bad, I was just trying to get on with the good. 

Julia Morahan: 

Jennifer, what would you say to others who are considering AHSCT? What factors do you think they should weigh up if they’re thinking of making this decision? 

Jennifer Massey: 

I think having a good understanding of what this treatment is, what it can offer, what it can’t offer, and obviously, as we’ve discussed, the risks are really the key. 

This is quite subspecialised medicine, quite subspecialised MS care, and so I’ve said this over and over again. We are always happy to see people in our clinic here at St. Vincent’s to answer questions that people may have because as you highlighted, Julia, there is a lot of, I suppose, misinformation or there’s a lot of media about stem cells across a range of neurological conditions, not just MS. 

Essentially, AHSCT is a really highly efficacious therapy for the inflammatory or relapsing part of MS. And so for some people that is clinical relapses, MRI lesions that are new and some people it’s both. That is despite being on the highly effective medications that we have now for the majority of people with MS. 

And so if people with MS have relapses or new MRI activity despite being on high efficacy therapies, then AHSCT I think is an important consideration. You’re sort of front loading your risks with this concept of immune ablation and immune reset, but we’ve certainly seen in the right patient population protracted periods of disease remission for many, many years, even out to decades. 

There’s many things, however, that AHSCT can’t do. Unfortunately, we’ve not seen any robust evidence that it makes a difference on what we call PIRA, this idea of progression independent of relapses. So some people might call that secondary progression or that gradual worsening that unfortunately many people with MS experience. 

The second thing is there’s a lot of symptoms that come with MS that I would say in the vast majority of people who have had AHSCT with us, those symptoms are not improved and unfortunately, that’s things like fatigue, cognitive fog. And so whilst we can seemingly stop relapses in many people, those kind of background, more silent symptoms don’t disappear. 

Stem cell transplant does not remove symptoms that have occurred from prior relapses or prior disease attacks. And so when I meet someone they’ve already got some weakness and tingling and clumsiness of their right hand, for example, we don’t expect that that will improve. 

Those are really the important things for someone considering this treatment to consider. 

And then I think there’s the place of AHSCT in someone’s life more generally. 

I touched on the fertility issue. So there may be people who would not be interested in pursuing AHSCT even if their MS may benefit because it doesn’t fit with their family. It may temporarily require people to be off work as Michael touched on and so that might not be compatible with someone’s current financial situation, for example. They might not be able to take a period of time off work. 

I would be hopeful that anyone who would be considering AHSCT would be happy to come and chat to us. So we could go through that in more detail as they need. 

Julia Morahan: 

Yeah, thank you for that. 

I think you touched a little bit on this, but I guess while we’ve got you here, we wanted to clear up the common misconceptions that when you are speaking to people that you hear in your clinics. I guess some of it is about the halting of relapse, I guess, but not necessarily making a huge dent in progression or symptoms relating to progression. 

And then also the idea that you might be able to reverse symptoms that already exist from previous activity. Is there anything else that you would like to stress while we have people listening? 

Jennifer Massey: 

Yeah, I think those are spot on, Julia. 

Again, we’ve touched on this, but the first big misconception is the idea that the stem cells have some kind of neuro regenerative or neuro restorative properties. And as you highlighted, these are not nerve stem cells, these are haematopoietic or blood stem cells. 

So basically, they allow us by collecting those cells before we give chemotherapy, when we put those cells back in, it means that the immune system can regrow quickly and in a way that makes this treatment safer than giving high dose chemotherapy alone. But these stem cells are not having any direct effect on prior demyelination or brain volumes or neural function. 

The second thing I think is that we chat a lot with about our patients is the almost Lazarus-like stories of people who had disease, who went overseas, had this treatment, and then had restoration of function. I think we just have to always be a little bit sceptical about what we see on social media or anecdotal stories because very much our experience has been that it’s effective at stopping relapses, new MRI lesions, but as I said, doesn’t result in improvement in function in the majority of people. 

The other comment, I guess, discussion that we have is many people saying, “I hear what you’re saying, I understand it might not do anything, but I still want to take the chance,” and I suppose the important thing there is just to highlight the fact that we can unfortunately make people worse with this therapy. It’s not necessarily a matter of, “I’ve got nothing to lose,” because with treatments like this, there is the capacity actually to unfortunately make things worse. So it’s really important that people are very considered when accessing this treatment. 

Julia Morahan: 

I think that’s good. Thanks, Jen. 

Michael, knowing what you know now, would you make the same decision again? 

Michael Butler: 

100%, yep. 

I was in a position where I didn’t have many options. I don’t regret it at all. I like to refer to it as pressing Control-Alt-Delete on my immune system. It gave me the chance of having hope for the future. 

Since doing the treatment, I haven’t had any new lesions. I still can’t walk properly, I walk slower than a turtle, but if I didn’t do the treatment, I have no idea whether I would be in a worse position now. So I’m very thankful that being able to do it. 

I like to think that it has helped; but it’s the unknown. You still don’t know. Would I be worse today if I didn’t do it? Don’t know. The fact is that I still can walk and I have nothing but thanks to the treatment for being in that position. 

Julia Morahan: 

Yeah, that’s wonderful. 

So I think this is probably a question that you get a lot, and everybody’s circumstance with MS is different and the treatment decisions that people make across the whole suite of treatments, I guess, is a very personal decision and varies very much from person to person. 

But as a person who has undergone AHSCT, what advice would you give to someone in a similar position or someone who was considering the treatment? 

Michael Butler: 

My advice would probably be to act fast rather than sitting back. I found over the years that the treatments got more aggressive in the way that neurologists treat their patients now. That wasn’t the case back in the day when I was diagnosed. 

And, yeah, I think go hard, go fast is the answer, like I said, because I was on those drugs that were very softly, softly treating you, whereas now they’re more aggressive and I think the results are showing that. 

Julia Morahan: 

Yeah, absolutely. The research absolutely backs that up, but you’re right. 

Michael Butler: 

Yeah, 20 years ago, I found neurologists would treat the symptoms, whereas now I find that, and Jennifer might correct me if I’m wrong here, they look more at the scans to work out where you’re at and, yeah, I just think the answer is use the strongest drug that you can to treat at the moment. 

Julia Morahan: 

Did you want to comment, Jen? 

Jennifer Massey: 

Yeah. Look, I would absolutely agree with what Michael said about evolutions in approaches to treatment. The historic approach was very much escalation, start low, go slow, build up when things get worse, and I think we now know that taking more of an induction approach, hitting hard, hitting early with the high efficacy therapies, results in the best chance of preventing future relapses and therefore, ideally, stalling off any/all disability. Obviously, that’s a fairly lofty goal, but that’s what we’re aiming for. 

And MRI scans certainly have become a bigger part of the picture, but I think my colleagues and I would all still agree that we are still interested in the patient. No, I’m being facetious. 

But, yeah, look, it’s a matter of looking through those things together and trying to balance the risk-benefit in every scenario. 

Julia Morahan: 

Yeah, I think I feel another podcast coming on about the changing attitudes to treatment in MS over time, honestly. 

This has been an incredible conversation for me. Thank you so much to both Jennifer and Michael for discussing their experiences and sharing their expertise with us. 

Before we wrap up, is there anything else you would like to add, Michael? 

Michael Butler: 

Yeah. I’d like to put a message out there for people to be proactive, rather than sitting back waiting for their symptoms to make up their mind for them and look at what you can do rather than what you can’t do with exercise. 

I listen to this podcast and hear stories of people doing marathons and climbing mountains and all that sort of stuff, which is fantastic, but it’s not realistic for everyone. 

Your biggest goal for the day might be to get from the bedroom to the kitchen to make a cup of coffee. That’s a big tick if you can do that. 

So don’t get disheartened by hearing people’s stories of doing, big, massive achievements because it’s not for everyone. Your achievement might be making that coffee and if you are able to do that, then you’re winning. 

I can’t go for a run anymore. I’d love to, but I can’t. But I can still use my upper body really well and I make sure that I do that every day in some way. 

My message would be do what you can while you can and if that gets limited in some way, find a new thing and a new goal. 

Julia Morahan: 

Jennifer, anything you’d like to add? 

Jennifer Massey: 

I suppose just to say that it’s important to have these conversations, as Michael highlighted, with your neurologist and that we are always happy to see people for opinion and advice as needed. 

Michael Butler: 

Can I just add something to that statement as well? 

I think it’s really important to find medical help that you’re comfortable with. 

I didn’t just land at St. Vincent’s from the very beginning. I found myself visiting, I think, three different neurologists before I ended up at St. Vincent’s. And it wasn’t until I was comfortable there and it became my safe place that I was comfortable with moving forward. 

It probably helped me with the decision to do the HSCT because I had that trust with a group of doctors that were there at the hospital, but I did have to, sorry for the term, doctor shop around until I was comfortable with someone to put that trust in them. And I was just lucky that I landed in an office where there was multiple neurologists that were fantastic to work with, and I still have that relationship today. 

But it took some time to get there because I had some not-so-great stories prior to that in the early days when I was trying to get diagnosed. I actually had an instance of being in hospital. 

The very first time that I thought to myself, “You need help,” was back in 2010 and I went to the emergency department at the local hospital and said, “I have MS, I need steroids.” And the doctor looked at me and said, “What’s MS?” And I was like, “I’m in the wrong place.” 

That’s when I had to go and find a group of doctors that I trusted, and I was just lucky to find my team at St. Vincent’s. 

Julia Morahan: 

Well, they are a very wonderful team at St. Vincent’s, so you are lucky. But I think it also highlights the importance of people being their own advocate. 

I think that’s a message that we would really like to highlight is if you feel the need to speak to other people or have a second opinion, as Jennifer has said, have conversations with other teams or other doctors, please do so because we do want people to be treated as well as possible as quickly as possible. So it is an important message. 

So, as we wrap up today’s episode, I would like to extend a heartfelt thank you to our guests, Michael Butler and Dr Jennifer Massey, for sharing their stories, insights, and expertise with us. 

We’ve explored the challenges of managing symptoms of MS to the importance of timely and effective treatment and to the profound impact AHSCT can and has had on individuals. 

Thank you for joining us today on The Raw Nerve. We hope this conversation has provided both knowledge and encouragement for those living with MS and their loved ones. Until next time, take care and stay well. 

Voiceover: 

Thanks for listening to The Raw Nerve, the official podcast of MS Australia.  To hear more, subscribe to our podcast today at msaustralia.org.au/podcast.  

Views expressed on the Raw Nerve Podcast, including any discussions or reference to medications or treatments by podcast guests, do not necessarily represent the views of MS Australia and should not be seen as either an endorsement or rejection of a treatment.

MS Australia does not recommend any specific treatment for people living with MS. Decisions about any treatments, taking into consideration the potential benefits and side effects for each individual’s circumstances, should be made in careful consultation with the person’s neurologist.

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A conversation about MS and AHSCT: Autologous Haematopoietic Stem Cell Transplant