Question reference: S6W-01751
- Asked by: Jackie Baillie, MSP for Dumbarton, Scottish Labour
- Date lodged: 22 July 2021
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Current status: Answered by Maree Todd on 6 August 2021
Question
To ask the Scottish Government by what date haematopoietic stem cell transplantation (HSCT) treatment for multiple sclerosis will be available to NHS patients.
Answer
In October 2019 the Scottish Health Technology Group (SHTG) recommended that: “Where patients understand and are willing to accept the demands, risks and uncertainties of treatment, autologous haematopoietic stem cell transplant (AHSCT) should be considered as a treatment option for patients with relapsing-remitting multiple sclerosis (RRMS) who have evidence of significant inflammatory disease activity that has not responded to adequate treatment with licensed high-efficacy disease modifying therapies (DMTs).”
Following comprehensive clinical assessment, relevant diagnostic testing and consideration by a specialist multi-disciplinary team, AHSCT can be offered to MS patients from Scotland where they meet this criteria and when it is clinically judged that the benefits of treatment outweigh the risks. In these circumstances such patients can be referred by their NHS Consultant for this specific treatment at a specialist centre in England.
Stem cell transplantation is currently undertaken in Scotland for other clinical reasons, however specific expertise in its use for the treatment of MS is still developing. In order to ensure that patients receive the highest level of safe, patient-centred care, clinical consensus is that this is currently best delivered by one of the most experienced centres globally, located in Sheffield. Although delayed by the need to focus resources on COVID-19, key stakeholders within NHS Scotland are continuing discussions regarding a potential Scottish pathway for this treatment.
AHSCT is an intensive treatment which carries a very high risk of infection for many weeks, due to severe immunosuppression as part of the treatment pathway. In March 2020 the Association of British Neurologists (ABN) recommended postponing this treatment in patients with MS until the risk of coronavirus receded, due to the potential for severe illness in those with compromised immune systems. As of November 2020, the ABN advises its use only in exceptional cases of relapsing disease.