Autologous HSCT for advanced MS: Is the glass half-empty or really half-full?

Sir, On the basis of persisting demyelination and axonal degeneration in brains of patients with progressive multiple sclerosis (MS), Metz et al. (2007) concluded that ‘autologous hematopoietic stem cell transplantation fails to stop demyelination and neurodegeneration’. This was based on routine and immunohistochemical stains of brains from five patients who died at a median of 2 (range 0.5–18) months after high-dose immunosuppressive therapy (HDIT) and autologous hematopoietic stem cell transplantation (HSCT). Although this small series of autopsy cases contributed significant and interesting insights, the conclusion in the title would appear to be an overstatement of what is actually in evidence. In a ‘Scientific Commentary’ in response to Metz et al. , Martin (2007) also noted limitations in the study, including the small size of the series and that four of the five patients died early after the intervention.A general concern regarding the examination of biopsy or autopsy materials from patients to evaluate the effectiveness of therapeutic interventions has been that it provides only a single time point for each patient assessment. …