czapski hit the nail on the head and correctly mentions the issue that I did not, but should have in my original explanation. The treated group of patients in the Greek study were also predominantly advanced progressive (both PP and SP) cases that were not ambulatory (EDSS range 6.0-8.0). Again, these are the patients that are known to respond "least" favorably to HSCT treatment. So many of these people never experienced a stopping of their disease activity at all, even from the very begining immediately following HSCT. So these "failed treatment" patients were included in the 15 year follow up numbers. From a statistical perspective that really skews the numbers and makes the wrong argument that "HSCT does not have long term benefit." Which is an absurdly false statement.
In actuality for HSCT treatment for MS patients since 2002, for every single patient that had their MS disease stopped, all (100%) of these same patients still have their disease stopped today. That's 100% effectiveness at 10 years out. A far different way to look at the data compared to the Greek study, even though both data are correct. It's all the way the data is presented and interpreted. Like Samuel Clemmons said. . . . "Lies, damn lies and statistics." So the lesson here is manifold. . . . Treatment earier in the disease lifecycle is more effective and treatment of patients while still ambulatory is more effective. Without digging further and depper into the Greek presentation and just looking superficially at the data I can see how some people could become discouraged by the data. But I rather look at the details to get the "real" story, which is this. . . .
The specific statistical "probability" that has been demonstrated for each morphological evolution groups (RR, SP, PP) for halting of underlying disease activity is as follows:Ealy RRMS-treated patients
Complete stopping of the disease process & progression in virtually 100% of treated patients.
Greater than 80% of the same treatment population experiences "significant" improvement (>1.0 point reduction of existing symptomatic EDSS). Many HSCT-treated patients in this group further report their pre-treatment symptoms completey dissappearing, 100%.
During the RRMS phase of the disease I would expect very good beneficial results following HSCT regardless of the EDSS-measured symptomatic disability at the time of treatment (highly effective in the entire EDSS range).Late SPMS (non ambulatory) treated patients
Stopping of MS disease progression in 78% of this treatment population.
EDSS improvement not population-quantified in this population and varies by individual.
Curative efficacy is not population-quantified in other patient EDSS stratum. So for SPMS patients with an ambulatory status (EDSS <6.0), the cure rate (stopping of diasease progression) is not well established, but certainly I would expect it to be greater than 78%. Probably in the range of 85% - 95%.
Just my own personal expeience data point (that does not necessarily translate to any other specific individual) that appears to be consistent and fairly representative of other (ambulatory) SPMS patients so far. . . . . I was RRMS for 11 years and then went SPMS for 4 years (EDSS 3.5) before my HSCT procedure. As of today (18 months post-transplantation) my disease is 100% stopped and my pre-existing symptomatic deficit (as measured by EDSS) has improved (reversed) 50%. So clearly it is possible that SPMS cases (especially those that are ambulatory) can experience good beneficial improvement from HSCT.Late PPMS (non ambulatory) treated patients
Stopping of MS disease progression in 66% of this treatment population.
EDSS improvement likely poor, if at all
So for the PPMS patients with an ambulatory status (EDSS <6.0), the cure rate (stopping of disease progression) is not well studied and not well established, but certainly I would expect it to be greater than 66% people in the PPMS population.
Also, for ambulatory PPMS cases, EDSS improvement is possible, but not gauranteed. This is a very un-studied and unknown area. I would expect this number of people in this poulation to show improvement somewhere in the chasm-like range of 1% - 65% of treated patients. Perhaps someday as more ambulatory PPMS patients are treated then this can be better quantified. For now, the treated population is so small its impossible to predict with any confidence.
But no matter what, HSCT has a far better chance of having a positve beneficial effect for MS patients of any evolutionary type as compared to any (every) other therapy anywhere in the world. So far, no other curative therapy can even come close in accomplishing what HSCT has already (scientifically and repeatably) demonstrated.
Here is a single graph that I created that provides a comparative overview of all the aforementioned data:http://2.bp.blogspot.com/-PvejGH-NIG4/T ... al%2B2.jpg