Autologous hematopoietic stem cell transplantation (aHSCT) uses chemotherapy to largely remove the immune system, then rebuilds it from the patient's own stem cells. For carefully selected people with highly active relapsing multiple sclerosis (MS), it can stop new inflammatory activity for many years. It does not repair existing nerve damage, and it carries real risks.

In Germany, aHSCT for MS is performed at university hospitals, where MS neurologists work with stem cell transplant specialists. The German MS Competence Network (KKNMS) has published national recommendations on who should be considered, most recently updated in 2025.

Eligibility is strict. Germany's recommendations generally focus on younger adults with active relapsing MS, moderate disability and a short disease duration, whose MS has not been controlled by highly effective medicines. A specialist assessment decides eligibility, not patient preference.

Cost. German hospitals do not publish any exact prices for aHSCT. However, it can range from €50,000 to €70,000 for the treatment programme. A hospital-specific quote is needed.

This guide explains who may qualify, how the treatment works, risks, time in Germany, estimated costs and how to be assessed.

What Is HSCT for MS?

In MS, the immune system attacks myelin, the protective coating around nerve fibres in the brain and spinal cord. HSCT aims to "reset" the immune system in four stages:

1. Stem cell collection. Blood-forming stem cells are moved from the bone marrow into the blood and collected.
2. Conditioning. High-dose chemotherapy, usually with an antibody treatment, removes most of the immune cells that drive MS.
3. Stem cell reinfusion. The stored stem cells are returned through a drip.
4. Immune rebuilding. The immune system regrows over the following months, and the new system is less likely to attack myelin.

For MS, only autologous transplantation is used, meaning the patient's own stem cells. Transplants using donor cells (allogeneic) are not used for MS because of their much higher risks.

HSCT is not the same as "stem cell therapy" clinics

Many clinics worldwide perform "stem cell therapy" for MS using mesenchymal or other cells, often as injections. These are not HSCT, and they do not have the same evidence. Regulated aHSCT is:

• a major procedure with chemotherapy
• performed in accredited transplant units
• carried out under neurological supervision

Be cautious about any clinic offering stem cell treatment for MS without chemotherapy, without a transplant unit, or without strict eligibility checks.

Who Is Eligible for HSCT for MS?

HSCT is considered for a small group of people with MS. The German position paper describes a core eligibility corridor:

The recommendation describes these as a corridor to be checked individually, not a checklist that must be fully met. European ECTRIMS/EBMT recommendations are similar. They also say aHSCT may be considered earlier, within studies, for very aggressive, rapidly evolving MS.

Usually not suitable:

• progressive MS without signs of active inflammation, where disability is driven mainly by nerve degeneration
• advanced disability
• significant heart, lung, liver or kidney disease, or active infection

In Germany, up to about 5% of people with MS have an aggressive course that might make them candidates.

What the Evidence Shows?

MIST trial. This international randomised trial of 110 people with highly active relapsing MS compared aHSCT with continued disease-modifying therapy (DMT).

• Disability. In the first year, disability progressed in 3 of 52 people after HSCT, compared with 34 of 51 on DMT.
• Relapses. One person in the HSCT group had a relapse, compared with 36 of 52 in the DMT group.
• EDSS scores. Average EDSS improved from 3.38 to 2.36 after HSCT and worsened from 3.31 to 3.98 on DMT.
• Safety. No deaths occurred in either group.

The comparison group did not include some of today's most effective drugs, such as ocrelizumab or alemtuzumab.

Newer head-to-head trials are comparing aHSCT with today's most effective MS medicines:

• StarMS (UK) compares HSCT with alemtuzumab, ocrelizumab, ofatumumab or cladribine. Recruitment was completed in 2024, and results are expected around 2027.
• RAM-MS compares HSCT with alemtuzumab.
• BEAT-MS (USA) compares HSCT with the best available DMT for each patient.

What to expect. In selected patients, aHSCT can:

• stop relapses and new MRI lesions for many years
• let many people stop MS medicines
• sometimes improve disability

It does not cure MS, reverse long-standing damage or guarantee permanent remission, and MS activity can return in some people.

Risks and Side Effects

aHSCT is a high-intensity treatment. Germany's patient information and position paper give the following figures:

• Treatment-related mortality: about 1% across all reported cases since the 1990s. It fell to about 0.2% in recent years (2017 to 2021) with better patient selection and experienced centres. The risk is higher in older people and those with more disability.
• Infections: very common during the period of low blood counts. Up to 70% have some infection in the first 100 days.
• Short-term effects: fever, mouth sores, nausea, hair loss, tiredness and allergic reactions to medicines.
• Fertility: chemotherapy can damage fertility and may cause early menopause. Egg or sperm freezing is recommended before treatment for people who may want children.
• Secondary autoimmune conditions: up to about 5%, most often thyroid disease.
• Cancer: a small long-term increase in cancer risk, estimated at 3%.
• Viral reactivation, such as Epstein-Barr virus or cytomegalovirus, which is monitored after transplant.

Because the immune system is rebuilt, childhood vaccinations usually need to be repeated after recovery.

How HSCT for MS Is Performed in Germany?

1. Assessment

Before anything is planned, a joint team of MS neurologists and transplant haematologists reviews:

• your MS history, relapses and treatments
• MRI scans, including recent scans with contrast
• your disability level (EDSS)
• heart, lung, kidney and liver function
• infection screening

2. Stem cell mobilisation and collection

Low-dose chemotherapy and a growth factor drive stem cells from the bone marrow into the blood. They are collected by apheresis, a machine process similar to blood donation, and frozen.

3. Conditioning and transplant

High-dose chemotherapy combined with an antibody is given over about four days. The stored stem cells are then thawed and infused.

4. Recovery in hospital

Blood counts are very low for about 10 days. Patients are cared for in a protected transplant unit until white blood cells recover.

5. The first 100 days

Close monitoring and preventive medicines against infection are needed during this period. Full immune recovery takes about one year.

6. Long-term follow-up

Regular neurological examinations and MRI scans continue for years. In Germany, patients are documented in the national RECLAIM registry, which tracks long-term outcomes of aHSCT for MS.

What HSCT in Germany Means for International Patients?

Access

aHSCT for MS is a specialised, low-volume procedure in Germany. The German position paper reported that only 57 of 1,721 MS transplants in the European registry up to 2021 were performed in Germany. Centres follow the national eligibility corridor and decide case by case. Some may not accept international patients, or may have limited capacity.

Start with a remote review of your records. This lets a German MS centre confirm whether you are likely to be eligible before you plan travel.

Time in Germany

Plan for around six to eight weeks in total. This covers assessment, stem cell collection, the gap before conditioning, the transplant and recovery until you are fit to travel. The exact schedule depends on the centre's protocol.

After returning home, you will need close local medical support during the first 100 days, because your immune system will be weak. Before travelling, confirm that a doctor at home can:

• check blood counts
• manage infections
• continue preventive medicines

Insurance

In Germany, statutory health insurers fund aHSCT for MS only on individual application, not as routine care. International patients usually pay themselves. Some international insurers may consider coverage with prior approval.

Centres Involved in HSCT for MS in Germany

The German position paper and registry were developed by MS and transplant specialists from several university hospitals. The centres below are named because their clinicians co-authored it. This does not confirm that each currently accepts international patients for aHSCT. Vaidam can check this for you.

When choosing a centre, check for:

• a joint MS neurology and transplant team with experience of aHSCT for MS specifically
• JACIE accreditation of the transplant unit (the European quality standard for stem cell transplantation)
• participation in the RECLAIM registry
• fertility preservation services
• a written estimate and a clear follow-up plan for after you return home

Cost of HSCT for MS in Germany

German hospitals do not publish fixed prices for aHSCT for MS. Cost depends on the protocol, length of stay, complications and the hospital's charges for international patients. Treat any figure as an estimate until you receive a written quote.

How International Patients Can Prepare?

Medical documents to gather

• A neurologist's summary: diagnosis date, MS type, relapses with dates, and current EDSS.
• All MS treatments you have received, with dates and reasons for stopping.
• MRI scans of the brain and spine (images, not only reports), ideally including scans from the last 12 months with contrast, plus earlier scans for comparison.
• Recent blood tests and infection screening, if available.
• Other medical conditions and current medications.
• Your wishes about fertility.

Reports in languages other than English or German may need translation.

Travel and administrative documents

Visa. Most non-EU patients need a visa for medical treatment. Because the stay is often longer than a short trip, check whether a national (D-type) visa is needed. Applications usually require the hospital's invitation letter with a cost estimate, proof of funds and health insurance.

Other items to arrange:

• proof of funds or an insurer's guarantee of payment
• accommodation near the hospital for the whole stay
• a companion for support during and after treatment
• a doctor at home to manage the first 100 days

Questions to Ask the Transplant Team

1. Do I meet the German eligibility criteria, and which ones am I outside of?
2. How many people with MS has your centre treated with aHSCT?
3. Which conditioning regimen do you use, and why?
4. What are my personal risks, given my age and disability?
5. How long will I need to stay in Germany?
6. What support will I need at home in the first 100 days?
7. Should I freeze eggs or sperm first, and can you arrange it?
8. Will I need to stop my current MS medicine before treatment, and when?
9. What follow-up will I need, and will I be included in the RECLAIM registry?
10. What does the cost estimate include and exclude?

Recovery After HSCT

• Hospital stay: usually several weeks, until blood counts recover.
• Fatigue: common for several months. Gentle, gradually increasing activity and rehabilitation help.
• Infection precautions: preventive medicines and hygiene measures, especially in the first 100 days.
• Temporary MS symptoms: existing MS symptoms may briefly worsen during and after treatment, usually settling as you recover.
• Return to work and daily life: often within about three to six months, depending on recovery.
• Follow-up: neurological reviews and MRI scans, usually for years.

How Vaidam Helps International Patients?

Vaidam Health is a medical travel facilitation service. It does not provide medical treatment itself. When you contact Vaidam, you are assigned a case manager who can:

• share your MS records and MRI scans with German university centres for an eligibility review
• obtain a medical opinion and written cost estimate
• help with visa documentation and the hospital's invitation letter
• arrange accommodation near the hospital, airport transfers and appointment scheduling
• arrange interpreters (in Germany, interpreter services are chargeable)
• stay in contact after you return home to help with follow-up consultations and reports

Vaidam states that its services are free for patients and do not increase the hospital bill. Eligibility and treatment decisions remain with the German neurology and transplant team.

Frequently Asked Questions

1. Is HSCT a cure for multiple sclerosis?

No. aHSCT can stop new inflammatory activity for many years in selected patients, and some people improve. It does not repair existing nerve damage, and MS activity can return in some people.

2. Who qualifies for HSCT for MS in Germany?

Generally, adults aged about 18 to 45 (sometimes up to 55) with active relapsing MS, an EDSS of about 3.0 to 6.0, disease duration of up to about 10 years, and ongoing activity despite highly effective medicines. A joint neurology and transplant team decides eligibility.

3. Can people with progressive MS have HSCT?

Only if there is still clear inflammatory activity, such as relapses or active MRI lesions, and disability is not advanced. HSCT is generally not recommended for progressive MS without active inflammation.

4. How much does HSCT for MS cost in Germany?

German hospitals do not publish prices. However, estimates suggest around €50,000 to €70,000 for the treatment programme, plus accommodation, fertility preservation and travel. A written hospital quote is needed.

5. How long will I need to stay in Germany?

Plan for about six to eight weeks, covering assessment, stem cell collection, the transplant and recovery until you are fit to travel. You will then need close medical support at home for the first 100 days.

6. What are the risks of HSCT for MS?

Infections are common during recovery. Treatment-related death is uncommon: about 0.2% in recent years at experienced centres, higher in older and more disabled patients. Other risks include infertility, thyroid and other autoimmune conditions, and a small long-term cancer risk.

7. Is HSCT better than MS medicines?

In the MIST trial, HSCT was much more effective than the medicines used at the time. Trials comparing HSCT with today's most effective drugs, such as StarMS, RAM-MS and BEAT-MS, are ongoing, with results expected from about 2027.

8. Will I still need MS medicines after HSCT?

Many people remain off MS medicines for years after successful aHSCT. Regular neurological follow-up continues, and treatment is restarted only if MS becomes active again.

9. Is HSCT the same as stem cell therapy offered by other clinics?

No. aHSCT involves chemotherapy and transplantation of your own blood stem cells in an accredited transplant unit. Many clinics sell other "stem cell" treatments for MS that do not have the same evidence and should be approached with caution.

10. How do I find out if I am eligible?

Send your neurologist's summary, treatment history and MRI scans for review. A German MS centre can advise whether you are likely to meet the criteria before you make travel plans.

Sources

• German MS Competence Network (KKNMS): recommendations on autologous stem cell transplantation for aggressive MS (updated 2025) and patient information on aHSCT (mortality, risks, fertility, insurance status).
• Bayas A et al. Autologous haematopoietic stem cell transplantation for multiple sclerosis: a position paper and registry outline. Therapeutic Advances in Neurological Disorders 2023 (eligibility corridor, RECLAIM registry, German patient numbers, mortality trends).
• ECTRIMS/EBMT recommendations for aHSCT in MS and NMOSD, Nature Reviews Neurology 2025, as summarised by the European Academy of Neurology.
• Burt RK et al. MIST randomised trial, JAMA 2019, as reported by Multiple Sclerosis News Today.
• MS Society UK: HSCT research evidence (MIST, StarMS, RAM-MS, BEAT-MS).
• Vaidam.com homepage (service descriptions).