#115: Stem Cell Therapy for MS – A Conversation with Prof. Christoph Heesen

Stem Cell Therapy

When does it make sense for MS patients, and who is eligible?

It’s mainly for patients with highly active relapsing MS – that means frequent relapses, increasing disability, and a relatively short disease duration. Ideally, patients are under 40 and have had MS for less than ten years. Even some progressive cases may be eligible if they’re still in the earlier phase.

But it’s important to understand: stem cell therapy can reset the immune system, but it doesn’t repair nerve damage. It destroys the existing immune memory – including vaccination history – and rebuilds it from scratch. That’s why it doesn’t help in later disease stages where neurodegeneration dominates.

Can you explain how the treatment is actually performed?

Of course. We’re talking about autologous stem cell therapy, where patients receive their own stem cells back. That’s safer than using donor cells, although the MS could in theory return.

First, we mobilize the stem cells with a mild chemotherapy (usually cyclophosphamide), so they move from the bone marrow into the bloodstream. We then collect them through a process called apheresis – similar to plasma donation. The stem cells are checked for quality, frozen, and stored.

A few days later, patients return for the main part: conditioning. That’s a high-dose chemotherapy which completely wipes out the immune system. Without stem cells, this would be fatal within weeks. But we reinfuse the collected stem cells, which then rebuild the immune system over the next 7 to 10 days. In Hamburg, patients typically stay 3 to 5 weeks in the hospital for this process.

After discharge, patients go through a cautious recovery phase, especially during the first three months. It takes about a year for the immune system to fully regenerate.

What are the main benefits – and what are the risks?

Studies show that inflammation is reduced more effectively than with any other current MS therapy. The goal is no evidence of disease activity – no relapses, no new MRI lesions, no progression. That’s achieved in 40% of cases with standard therapies, and in 60–80%, maybe even 90% with stem cell therapy.

Another hopeful aspect: about one-third of patients may actually improve, because the immune attacks stop and the body’s repair mechanisms can work again. That’s why younger patients tend to benefit most.

But yes, the therapy is high-risk. In earlier days, 3–5% of patients died – mostly due to more toxic chemotherapies or pre-existing health conditions. Today, the mortality risk is under 1%. Still, it’s a serious decision. In Hamburg, Germany, we’ve treated 20 patients so far – none have died.

There are also risks of secondary autoimmune diseases (5–6%), secondary cancers (3–4%), and infertility – in both men and women. Fertility preservation is something we always recommend.

How do you support patients through the decision process?

Most patients who come to us are already well informed – often through online communities like the German-speaking Facebook group for MS transplant recipients. We start with an initial consultation, give them time to consider, and continue the conversation from there.

For most, this therapy is an option when nothing else has worked and their quality of life is severely affected. Then, risk and benefit can be meaningfully weighed.

What’s the total treatment timeline?

About a year. One week for mobilization, 3–5 weeks inpatient for the transplant, and at least three months of close follow-up. After that, it’s up to the patient when to pursue rehab – some wait up to a year to avoid the risk of infection from public facilities.

Is rehabilitation recommended?

There’s no specific rehab protocol. Some patients feel very weak at first, others bounce back quicker. MS-specific rehab is generally a good idea, and staying physically active helps recovery.

What if someone has small children?

Kids don’t usually bring home dangerous infections, so the risk is manageable – especially if you can keep some distance for the first few months. But of course, the emotional strain from that separation is real, so we always talk through it individually.

Costs and Study Participation

Let’s talk about the cost. Who pays for this therapy?

In Germany, stem cell therapy for MS is not covered by health insurance as a standard treatment. Some patients manage to get approval from their insurer. Otherwise, self-payment is possible – around €35,000 to €40,000. Some go to Switzerland, London, Mexico, or Russia.

At UKE Hamburg, we only offer the treatment through a clinical study or with insurance approval.

What makes the study in Hamburg unique?

It’s for patients with relapsing MS who have failed standard treatments, are under 50, and have had MS for less than 10 years. We compare stem cell therapy with Lemtrada or Ocrevus, aiming to show that stem cells are not only more effective, but also more cost-efficient in the long term – which could lead to insurance coverage.

Participants have a 50% chance of receiving stem cell therapy. Those who don’t may receive Lemtrada or Ocrevus. If those don’t work, they can still receive the transplant later.

Similar U.S. studies showed that about half of the patients eventually received the transplant anyway. We need 50 patients total, and we expect that will take around five years.

Other study sites in Germany currently include Mannheim and Dresden, with Düsseldorf potentially joining. Patients from across the country are welcome.

Quickfire Round

Complete the sentence: “For me, multiple sclerosis is…”

…a highly variable disease that requires high-end, industrial-strength therapies.

What breakthrough would you like to see in the next five years?

I hope stem cell therapy becomes established as a standard option. Also, I’d love to see more awareness around physical training and endurance as a means of regeneration and prevention.

And finally – what message would you like to leave for listeners?

Find your own path with MS. And look for doctors who will support you on it.