Efficacy and safety of autologous hematopoietic stem cell transplantation (AHSCT) versus alemtuzumab in multiple sclerosis: Systematic review and individual patient data meta-analysis.
Naima Kebir, Salem Waleed, Yousef A El Sayed et al.
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In 30 seconds
This systematic review and individual patient data meta-analysis compared autologous hematopoietic stem cell transplantation (AHSCT) with alemtuzumab in highly active multiple sclerosis. It included 10 observational studies with 1,887 patients. AHSCT was associated with a higher probability of EDSS improvement (HR 2.12, 95% CI 1.38-3.27) and better relapse-free survival (HR 0.33, 95% CI 0.19-0.58). No significant differences were found in disability progression, MRI activity, overall adverse events, or mortality. The authors rated the evidence very low certainty and considered the findings hypothesis-generating.
Key findings
- AHSCT was associated with greater probability of EDSS improvement than alemtuzumab (HR 2.12, 95% CI 1.38-3.27).
- Relapse-free survival favored AHSCT (HR 0.33, 95% CI 0.19-0.58), with low heterogeneity.
- NEDA was more likely with AHSCT (HR 0.39, 95% CI 0.22-0.67); disability progression and MRI activity did not differ significantly.
- Autoimmune thyroid disease was more frequent with alemtuzumab (RR 0.39, 95% CI 0.30-0.49); infection estimates were highly imprecise.
Why it matters
The comparison addresses two high-efficacy immune reconstitution therapies for highly active MS, where direct comparative evidence is limited. The observed associations suggest possible differences in inflammatory disease control and disability recovery, while the absence of clear differences in other outcomes and the very low certainty underscore the need for cautious interpretation.
What to keep in mind
Evidence came from observational studies, and the authors rated its certainty very low. Infection-related estimates were highly imprecise; randomized trials are needed to establish comparative effectiveness and safety.