The UCI Health bone marrow transplant program is now offering leading-edge stem cell therapy usually reserved for blood cancers to halt progression of multiple sclerosis, a neurodegenerative autoimmune disease.
Jessica Reinhardt was the first to undergo the treatment — using her own blood cells in a procedure called autologous hematopoietic stem cell transplantation (aHSCT) — in April 2022 at UCI Medical Center, one of a handful of U.S. hospitals to offer the experimental therapy outside clinical trials.
So far, three patients with multiple sclerosis have received aHSCT and another patient had the treatment for a different autoimmune disorder, all with promising results, says Dr. Stefan O. Ciurea, director of the Hematopoetic Stem Cell Transplant and Cellular Therapy Program at the UCI Health Chao Family Comprehensive Cancer Center.
“I feel reborn,” says Reinhardt, who is contemplating a return to sailing and exploring the far corners of the world as her strength gradually returns. “I want people to know they have this option. I’m very passionate about this because most MS patients aren’t aware it even exists.”
Multiple sclerosis (MS), which affects an estimated 1 million Americans, can trigger symptoms ranging from pain, numbness and tingling to fatigue and even paralysis, as well as mood and memory problems. It’s characterized by periodic relapses that can last from weeks to months and get progressively worse. There is no cure.
“MS is one of the leading causes of disability among young people,” says UCI Health MS specialist Dr. Michael Y. Sy, who is Reinhardt's neurologist.
Years of vague symptoms
The chronic disorder also can be very difficult to diagnose.
When Reinhardt was growing up in New York, a bad case of mononucleosis and sinusitis landed the teenager in the hospital, where a precautionary MRI scan revealed a grape-sized spot on her brain. Her doctors first suspected a brain tumor but a series of follow-up scans showed it wasn’t growing as a tumor would.
“They now think that was the first sign of multiple sclerosis,” explains Reinhardt, now 40, who lives in Corona del Mar.
In the years after that first MRI, she had other mysterious health problems. An adventurous young adult who climbed mountains in Nepal and traveled to Brazil to study the dance-like martial art of capoeira, even her extreme fitness didn’t prevent occasional painful falls.
She was also plagued by headaches. In her mid-30s, she was crippled by leg pains while traveling in Europe. “In Italy, my calves locked up so severely I had to take three or four days off and just lie down in an Airbnb.” In 2018, she quit her gym because she was too tired to go.
In spring 2019, when she couldn’t see out of her left eye after LASIK surgery and her head throbbed in pain, her optometrist sent her to an Orange County emergency room. A few days later, a doctor there showed her an MRI displaying the same grape-sized spot in her frontal lobe. Now there were others — on her optic nerve, on the corpus collosum, the part of the brain that allows the left and right lobes to communicate, and on her spine in her neck.
Those spots, it turned out, were telltale MS lesions where the insulating myelin layers that enable nerve cells to conduct electrical impulses had been destroyed.
Facing a grim future
Even with costly medications intended to slow the disease’s progression — with varying rates of success — it was a challenge to get through each day, let alone continue working as a certified sommelier or enjoy the travel and active recreation she loved. “You slowly lose your life to it,” Reinhardt says.
In her quest for effective treatments, she read about aHSCT, an immunosuppressive therapy used primarily for blood cancers but increasingly being offered to treat MS in Europe and elsewhere. It’s an arduous, months-long process that includes shots to boost bone marrow production of healthy blood stem cells and a prolonged post-transplant recovery. But it offered a chance to prevent relapses.
Initially, she and her husband, Nadeem, an engineer and a technology company executive, planned to travel to Germany, Singapore or the United Kingdom, where aHSCT is available for MS. Then Sy told her that UCI Health had begun offering the procedure.
Launched in 2020, the fast-growing stem cell transplant program recently won accreditation by the Foundation for the Accreditation of Cellular Therapies, a standard the National Multiple Sclerosis Society considers a “crucial” requirement for patients seeking aHSCT. California also has certified the program as a Medi-Cal Center of Excellence for adult bone marrow transplantation.
Reinhardt and her husband were over the moon. Instead of traveling across the world, she says, “I could have the transplant in my backyard.”
Therapy gaining acceptance
Although aHSCT is generally only available to U.S. patients through MS clinical trials, Ciurea says recent reports have emerged showing its effectiveness for MS.
Results of a study of 120 British MS patients published in 2021 indicated that no new lesions were found on MRIs in 90% of subjects two years after treatment, and no new damage in 85% of them after four years, suggesting that most may not need further therapy.
Sy says other studies show that 60% to 65% of MS patients showed no progression of disease or disability five years after aHSCT.
“It still is unclear to what degree existing neurological damage is reversible, but we believe this may be happening, too,” adds Ciurea, who emphasized that the procedure is extremely safe, with “very low toxicity and very low treatment-related mortality — close to zero.”
Even so, aHSCT is a lengthy, complex process. Reinhardt took daily drug injections for two weeks to stimulate her bone marrow to produce and move more stem cells into her bloodstream, where they are more easily collected. That was followed by a four-hour process called apheresis to collect her blood, filter out the fresh stem cells and return the rest to her body.
Next came a course of powerful chemotherapy drugs to wipe out her overactive immune system, which had been attacking her nerves, leaving her feeling weak with little appetite and bouts of nausea. “At that point, you have no functioning immunity, less than a newborn baby,” she says.
An immune system reborn
Finally, on April 7, she was infused with her new blood stem cells and spent three weeks in an isolation room while her body began to build a new immune system.
“I tell patients it’s like wiping out your hard drive and reinstalling Windows,” Sy says.
She went home to recuperate in late April, armed with antibiotics and antiviral medications to help shield her from serious infections.
“Dr. Ciurea told me I would see some improvement around the three-month mark,” she recalls. “Literally on day 90, all of a sudden, I’m getting out of bed in the mornings and I’m out gardening!”
Although Reinhardt is still regaining her physical strength and endurance, she feels the difference. “It’s like night and day. My family says I’m a new person.”
She also has a new mission: spreading the word about aHSCT on social media and increasing access for other MS patients. That will mean pushing insurance companies to cover the procedure’s cost, an estimated $150,000 — which she contends is cheaper and more effective than a long-term regimen of the expensive MS drugs they do cover — and persuading more U.S. doctors to perform it.
UCI Health has a long history in pioneering MS research and treatments, notes Sy. This partnership with the stem-cell transplant program is yet another noteworthy advance. It comes as new research at UCI and elsewhere posits that aHSCT may also be effective for other incurable autoimmune diseases.
For Reinhardt, the transplant “has been life-changing.” She regards April 7 as a new birthday. “It’s truly a gift, and I want to spend my life helping other people with MS get this therapy.”