HSCT or Mavenclad for MS: How the Two Treatments Compare
Medically reviewed by the board of haematologists at HSCT Hospital India, whose transplant physicians hold DM Clinical Haematology qualifications and fellowship training in stem cell transplantation. The programme runs at a JCI-USA, NABH and NABL accredited hospital that has treated more than 1500 patients.
Last reviewed: 5 October 2026. This guide cites peer-reviewed studies, which are listed at the end.
Mavenclad is the brand name of cladribine tablets, a medicine for relapsing multiple sclerosis. It is taken by mouth in four short treatment weeks spread over two years, and no further doses are needed in years three and four. HSCT, short for autologous haematopoietic stem cell transplantation, is given once. It uses chemotherapy to clear the immune cells that damage the nerves in MS, and then returns the patient’s own stem cells so the immune system can recover.
Doctors call both treatments immune reconstitution therapies. This means each one lowers a large part of the immune system and lets it regrow, rather than controlling MS with a medicine taken every day for years. Because of this, Mavenclad and HSCT are often weighed against each other by patients whose MS is still active.
HSCT Hospital India has treated more than 1,500 MS patients from over 30 countries since 2016. It uses the non-myeloablative protocol developed by Dr Richard Burt, in a JCI-USA accredited hospital that also holds NABH and NABL accreditation. The whole programme costs one all-inclusive price of US $30,000 for up to 30 days in hospital, and there is no long waiting list.
How do Mavenclad and HSCT act on my immune system?
Mavenclad and HSCT both lower the white blood cells that drive MS. In MS, these immune cells damage myelin, the protective coating around the nerves of the brain and spinal cord. That damage disturbs the signals that control sight, movement and feeling.
Cladribine, the medicine in Mavenclad, is taken up mainly by lymphocytes, the group of white blood cells that includes T cells and B cells. Inside these cells it builds up and causes them to die off. After each treatment year, lymphocyte numbers fall and then recover over the following months, which is why your blood counts are checked during and after each course.
HSCT acts on the immune system in a different way. At HSCT Hospital India, chemotherapy with cyclophosphamide and ATG, short for anti-thymocyte globulin, clears the T cells and B cells behind your MS. Your own stem cells, collected and frozen earlier in the stay, are then returned to you. These stem cells produce new immune cells, and for most patients no MS medicine is needed afterwards.
How do HSCT and Mavenclad compare, side by side?
Patients weighing the two treatments usually ask the same six questions. The answers are based on research and prescribing information published up to October 2026.
| Question | HSCT at HSCT Hospital India | Mavenclad (cladribine tablets) |
|---|---|---|
| How is it given? | It is given during one hospital stay of up to 30 days in New Delhi. | It is taken as tablets at home, in two treatment weeks a year for two years. |
| What follow up does it need? | Blood tests are taken often in the first months, and then you have regular check ups. | Blood counts are checked before each treatment year and two and six months after it starts. |
| What does it act on? | It clears the T cells and B cells involved in MS, and your own stem cells then produce new immune cells. | It lowers lymphocytes, including T cells and B cells, which then recover over months. |
| What has research shown? | In the MIST trial, disability got worse in 3 of 52 patients after HSCT, against 34 of 51 who stayed on MS drugs. | In the CLARITY trial, relapses fell to 0.14 a year on cladribine, against 0.33 a year on placebo. |
| What are the main side effects? | They are mostly short term, from the chemotherapy, and are treated in hospital as they happen. | A low lymphocyte count is expected, and shingles is more common than on placebo. |
| What does it cost? | One all-inclusive price of US $30,000 covers the whole programme. | The cost covers the tablets and the blood tests, paid by you, your insurer or your health service. |
The two trials in the table compared each treatment with something different. MIST compared HSCT with the MS drugs patients were already taking, while CLARITY compared cladribine with a dummy tablet, called a placebo. For this reason the two results show what each treatment achieved, but they cannot be set against each other as a direct comparison.
What is Mavenclad, and who is it given to?
Mavenclad was approved in Europe in 2017 and in the United States in 2019. In the United Kingdom, its current product information lists it for adults with relapsing MS that is active on clinical signs or MRI scans. Relapsing MS is the form in which symptoms come in attacks, called relapses, with periods of partial or full recovery between them.
In the United States, the label carries a boxed warning about cancer risk and harm to an unborn baby. It is generally kept for patients whose MS has not responded well enough to another MS medicine, or who cannot take one. Mavenclad is not given during pregnancy, and contraception is needed during treatment and for at least six months after the last dose.
The total dose is worked out from your body weight. Each treatment year has two treatment weeks, one in the first month and one in the second. Each treatment week is four or five days of one or two 10 mg tablets a day.
How well does Mavenclad work for MS?
Mavenclad was approved on the results of a randomised trial called CLARITY, published in 2010. In a randomised trial, patients are assigned to one treatment or another by chance. CLARITY followed 1,326 people with relapsing remitting MS for 96 weeks.
Patients on the approved dose of cladribine had 0.14 relapses a year, against 0.33 for patients on placebo. This means about 58 per cent fewer relapses. Cladribine also lowered the risk of disability getting worse and the amount of new activity on MRI scans over the two years.
What happens during HSCT at HSCT Hospital India, compared with a course of Mavenclad?
A course of Mavenclad is taken at home, with blood tests arranged by your neurologist. HSCT at HSCT Hospital India is a single in-patient stay of up to 30 days, and your attendant shares your private room throughout. The stay opens with a full medical evaluation, followed by four stages of treatment in a fixed order.
The four stages are mobilisation, collection, conditioning and reinfusion. In the first two, a growth factor and a short course of chemotherapy move stem cells from the bone marrow into the blood. A machine then collects them over several hours, a little like giving blood, and they are frozen until they are needed.
Conditioning is the chemotherapy with cyclophosphamide and ATG, given through a drip over several days. ATG can bring a fever, chills or a rash while it runs, and nurses treat these as they happen. Your frozen stem cells are then thawed and returned through a drip, and within days they start producing new blood cells.
In the days after reinfusion your white cell count is very low, a stretch doctors call the aplastic phase. HSCT Hospital India keeps every patient in hospital through this period. The private room has Triple HEPA air filtration and nursing around the clock, so any fever is treated immediately.
The full sequence, from your first enquiry to your flight home, is on the page about how HSCT works at HSCT Hospital India.
Send your diagnosis, your latest MRI report and the MS medicines you have tried, including Mavenclad, through the enquiry form. The HSCT specialist doctors at HSCT Hospital India review every case without charge, and an HSCT Case Manager replies to you by email.
Has HSCT been compared with Mavenclad in research?
No completed study has compared HSCT with Mavenclad directly yet. Two randomised trials are doing so now, and both include cladribine among the medicines HSCT is measured against.
In the United Kingdom, the StarMS trial is enrolling 198 patients with highly active relapsing remitting MS. It compares HSCT with alemtuzumab, ocrelizumab, ofatumumab or cladribine, and its main measure is how many patients have no sign of MS activity over two years. In Norway, the RAM-MS trial compares HSCT with alemtuzumab, cladribine or ocrelizumab.
The strongest randomised evidence for HSCT so far comes from the MIST trial, published in 2019 in the Journal of the American Medical Association. MIST randomly allocated 110 people with relapsing MS to HSCT or to the MS drugs then in use. Disability got worse in 3 of 52 patients after HSCT, against 34 of 51 of those who stayed on drugs.
MIST used cyclophosphamide with ATG, the same combination used at HSCT Hospital India. Average disability scores went down after HSCT, from 3.38 to 2.36, and went up on drugs, from 3.31 to 3.98. Disability is measured on the EDSS, the 0 to 10 scale doctors use in MS.
What side effects should I expect from each treatment?
The side effects of the two treatments arrive at different times. With HSCT, most side effects come during the 30 day stay, while HSCT Hospital India is looking after you. With Mavenclad, the main effect is a fall in lymphocytes after each treatment year, which is why blood counts are checked for months after each course.
A low lymphocyte count is expected with Mavenclad, because that is how the medicine works. Your count must be normal before the first year and at least 800 cells per cubic millimetre before the second year. In a pooled analysis of 923 patients, shingles was about four times as common on cladribine as on placebo. Shingles is treated with antiviral medicine when it appears.
Cancers were also reported a little more often on cladribine, at about 0.29 a year per 100 patients against 0.15 on placebo. For this reason Mavenclad is not given to people with an active cancer, and routine cancer screening is advised.
With HSCT, the side effects come mainly from the chemotherapy and the weeks of low immunity. Hair loss is expected, and hair usually starts growing back from about three months. Nausea is treated with anti-nausea medicine, and tiredness eases as your blood counts rise.
Infection is the main risk while your immunity is low, and fever is common in this stretch. For this reason the whole stay at HSCT Hospital India is in-patient, in a Triple HEPA filtered room with nurses present day and night. Medicines to prevent infection also continue after you go home.
Cyclophosphamide can affect fertility. Fertility preservation is discussed with you before treatment begins. Further detail is on the page about the side effects of HSCT for MS.
HSCT Hospital India emails its brochure to any patient who asks for it. The brochure covers the treatment, the 30 day stay and everything the one price includes.
I have taken Mavenclad. Can I still have HSCT?
Yes, patients who have taken Mavenclad are reviewed for HSCT. Many patients reviewed at HSCT Hospital India have already tried one or more MS medicines. What decides the case is whether your MS is still active, and whether HSCT is likely to help you.
The HSCT specialist doctors look at the dates of your Mavenclad treatment weeks and your recent lymphocyte counts. Your lymphocytes need time to recover after cladribine, so they advise you on how much time should pass before HSCT. The decision is made together with your neurologist at home.
How does HSCT Hospital India review a patient who has taken Mavenclad?
Every referral to HSCT Hospital India is reviewed by its multi-disciplinary team of HSCT specialists before any decision is taken. The team reads the EDSS recorded by your treating neurologist, your MRI scans in order over time and your relapse history. For a patient who has taken Mavenclad, this shows whether MS activity has returned since the last treatment year.
The review is free, and there is no obligation to go ahead. An HSCT Case Manager writes back to you personally with the doctors’ opinion and answers your questions about the stay. Because there is no long waiting list, a patient who is accepted can plan a treatment date without a long wait.
Send your diagnosis, your latest MRI report and the dates of your Mavenclad treatment weeks through the enquiry form. The HSCT specialist doctors at HSCT Hospital India review every case without charge, and an HSCT Case Manager replies to you by email.
Whose MS is HSCT at HSCT Hospital India most likely to help?
HSCT works best on MS that is still inflammatory, meaning relapses or new or enlarging lesions on an MRI from the past year. Lesions are areas of damage to myelin that show up on the scan. This is the same group of patients Mavenclad is given to.
HSCT Hospital India reviews people up to around 60 years old with an EDSS of 6.5 or below. At 6.5, walking usually needs two sticks or a similar aid. Relapsing remitting, secondary progressive and primary progressive MS are all considered.
Patients older than 60 or with a score above 6.5 are still reviewed one by one, and the doctors explain what their scans show. The complete criteria are on the page about HSCT eligibility at HSCT Hospital India.
What does HSCT Hospital India provide during the 30 day stay?
Once HSCT is the choice, the next decision is where to have it. HSCT Hospital India has treated more than 1,500 MS patients from over 30 countries since 2016. Its hospital holds JCI-USA accreditation, an international standard for hospital quality and patient safety, as well as NABH and NABL accreditation.
HSCT Hospital India uses the non-myeloablative protocol developed by Dr Richard Burt, the same approach tested in the MIST trial. Non-myeloablative means the chemotherapy weakens the bone marrow without destroying it. Because of this, blood counts recover sooner, and no further chemotherapy or MS treatment is needed after you leave the hospital.
Care is organised around the risk of infection. You stay in a deluxe private room with Triple HEPA air filtration for the whole treatment. Nurses are present day and night, and your attendant stays with you. Neuro-physiotherapy, meaning exercise sessions a physiotherapist plans for your strength and balance, runs through the stay.
The whole 30 day treatment is given in hospital, with no stay in an outside hotel or apartment. This matters most during the aplastic phase, when your immunity is lowest. Nursing care runs 24 hours a day, so a fever at that point is treated immediately.
The cost is agreed before you book travel. One all-inclusive payment of US $30,000 covers pre-testing, MRI, the full HSCT treatment and up to 30 days in hospital. It also covers doctors’ fees, tests and consultations, medicines, consumables and physiotherapy. Food and laundry for both you and your attendant are included, and so are airport pick-up and drop-back. An HSCT Case Manager supports your Indian medical visa application and remains your contact from the first email to the flight home.
Travelling to New Delhi raises questions about flights, the Indian medical visa and bringing a family member. An HSCT Case Manager can phone you to go through them, free of charge.
What do patients treated at HSCT Hospital India say about their HSCT?
Patients from the United Kingdom, the United States and more than 30 other countries have described their treatment at HSCT Hospital India on video, in their own words. The results they describe are their own, recorded during or after their stay.
Jayne, multiple sclerosis, United Kingdom
Jayne travelled from England with multiple sclerosis, with her mother in law as her attendant. Before treatment she could not walk well, her balance was poor, and fatigue was her main symptom. About a week after her stem cells went back in, her mother in law describes her standing up by herself, with her feet no longer dragging.
"Every day has got better and better."
Jayne, MS patient from the United Kingdom
Her full account is on the page Jayne from the United Kingdom.
Kathryn, multiple sclerosis, United States
Kathryn had lived with MS for 30 years when she came to HSCT Hospital India, with her friend of 40 years, Corrinne, as her attendant. By the end of the stay, Corrinne says, Kathryn could walk better, could feel things she had not felt before, and her vertigo had gone.
"I have had nothing but great service and great doctors and great nurses here. They are very concerned about not only my health needs but my personal needs."
Kathryn, MS patient from the United States
Her full account is on the page Kathryn from the United States. More accounts, including Janet from Canada, are on the patient stories page.
What follow up do I have at home after HSCT?
You leave India with no further chemotherapy to take, and most patients have no ongoing MS medicine either. Two documents go home with you. The Discharge Summary records the treatment you had, written for your own GP or neurologist. The Aftercare Manual lists your medicines, your blood test schedule and the dates for returning to normal activities.
Your blood results are shared with HSCT Hospital India after you go home. This means the HSCT specialists who treated you follow your recovery, and your neurologist can contact them with any question.
Blood tests check your counts twice a month for the first two months, and then once a month until they are normal. Usual activities typically resume after 2 to 4 months. Full recovery usually takes 3 to 12 months, and the page about recovery time after HSCT for MS explains it stage by stage.
How do the costs of HSCT and Mavenclad compare?
HSCT at HSCT Hospital India is paid once, as one all-inclusive price of US $30,000 for the treatment and the 30 day stay. Your travel to New Delhi and your check ups at home are the other costs to plan for. Insurance, tax relief and fundraising routes are covered on the page about how to pay for HSCT abroad.
Mavenclad is paid for over two treatment years, and the blood tests continue after each course. Your insurer or MS clinic can tell you what Mavenclad and its monitoring cost under your own plan. Prices for HSCT in other countries are compared on the page about HSCT cost by country.
The HSCT specialist doctors at HSCT Hospital India can tell you whether HSCT suits your MS, including if you have taken Mavenclad. The review costs nothing, there is no obligation, and an HSCT Case Manager replies to you personally.
Answers to Frequently Asked Questions (FAQs) about HSCT and Mavenclad for MS
Is HSCT more effective than Mavenclad for MS?
No completed study has compared HSCT with Mavenclad directly, so there is no head to head answer yet. In the MIST trial, disability got worse in 3 of 52 patients after HSCT, against 34 of 51 who stayed on MS drugs. In the CLARITY trial, cladribine lowered relapses to 0.14 a year, against 0.33 on placebo. The StarMS trial in the United Kingdom and the RAM-MS trial in Norway are now comparing HSCT with cladribine directly.
Is Mavenclad a form of chemotherapy?
Cladribine, the medicine in Mavenclad, is also given by injection at higher doses as chemotherapy for a blood cancer called hairy cell leukaemia. For MS it is taken as tablets at a lower dose, and it lowers lymphocytes for some months. HSCT uses chemotherapy once, during the conditioning stage, followed by the return of your own stem cells. At HSCT Hospital India the chemotherapy is cyclophosphamide with ATG, the combination used in the MIST trial.
How is Mavenclad taken, and how is HSCT given?
Mavenclad is taken at home in two treatment years. Each year has two treatment weeks, one in the first month and one in the second, with four or five days of tablets in each week. HSCT at HSCT Hospital India is one in-patient stay of up to 30 days in New Delhi, covering mobilisation, collection, conditioning and reinfusion. After HSCT, no further chemotherapy is needed, and most patients take no MS medicine afterwards.
Can I have HSCT after Mavenclad?
Yes, patients who have taken Mavenclad are reviewed for HSCT at HSCT Hospital India. The HSCT specialists look at the dates of your treatment weeks, your recent lymphocyte counts, your MRI scans over time and your relapse history. Because lymphocytes take time to recover after cladribine, they advise you on how much time should pass before HSCT. The decision is made together with your neurologist at home.
Which is safer, HSCT or Mavenclad?
The two treatments carry their risks at different times and in different ways. With HSCT, most side effects come in the first weeks, while immunity is low, and HSCT Hospital India keeps every patient in hospital through that period in a Triple HEPA filtered private room. With Mavenclad, lymphocytes fall after each treatment year, and shingles was about four times as common as on placebo in a pooled analysis of 923 patients. Cancers were also reported a little more often on cladribine than on placebo.
Why does Mavenclad need blood tests?
Mavenclad works by lowering lymphocytes, so their count is checked to make sure it does not fall too far. The count must be normal before the first treatment year and at least 800 cells per cubic millimetre before the second. It is checked again two and six months after each treatment year starts. If the count is too low, the second year of treatment is delayed until it recovers.
Does HSCT work for MS that stayed active on Mavenclad?
HSCT is aimed at MS that is still inflammatory, meaning relapses or new MRI lesions in the past year, and MS that stays active after Mavenclad fits that description. HSCT Hospital India reviews such patients up to around 60 years old with an EDSS of 6.5 or below. Patients outside those limits are still reviewed one by one, and the doctors explain what their scans show.
How do the costs of HSCT and Mavenclad compare?
HSCT at HSCT Hospital India is one all-inclusive price of US $30,000. It covers pre-testing, MRI, the full treatment, up to 30 days in hospital, food and laundry for you and your attendant, and airport transfers. Mavenclad is paid for over two treatment years, with blood tests during and after each course, so its total cost depends on your country and your insurance.
Can I get pregnant after Mavenclad or HSCT?
Mavenclad is not given during pregnancy, and women need contraception during treatment and for at least six months after the last dose. Men need to prevent a partner’s pregnancy for at least three months after the last dose. Cyclophosphamide, the chemotherapy used in HSCT, can affect fertility, so fertility preservation is discussed with you before treatment begins at HSCT Hospital India.
Can a family member stay with me in India?
Yes, your attendant shares your deluxe private room at HSCT Hospital India for the whole stay. Their food and laundry are part of the one price of US $30,000. An HSCT Case Manager also supports your Indian medical visa application and stays your contact until the flight home.
This page was medically reviewed on 5 October 2026 against the published research listed below.
References
- Giovannoni G, Comi G, Cook S, et al. A placebo-controlled trial of oral cladribine for relapsing multiple sclerosis. New England Journal of Medicine. 2010;362:416-426. doi:10.1056/NEJMoa0902533.
- Cook S, Leist T, Comi G, et al. Safety of cladribine tablets in the treatment of patients with multiple sclerosis: an integrated analysis. Multiple Sclerosis and Related Disorders. 2019;29:157-167. doi:10.1016/j.msard.2018.11.021.
- Leist T, Cook S, Comi G, et al. Long-term safety data from the cladribine tablets clinical development program in multiple sclerosis. Multiple Sclerosis and Related Disorders. 2020;46:102572. doi:10.1016/j.msard.2020.102572.
- Burt RK, Balabanov R, Burman J, et al. Effect of nonmyeloablative hematopoietic stem cell transplantation vs continued disease-modifying therapy on disease progression in patients with relapsing-remitting multiple sclerosis: a randomized clinical trial. JAMA. 2019;321(2):165-174. doi:10.1001/jama.2018.18743.
- StarMS protocol. Efficacy and safety of autologous haematopoietic stem cell transplantation versus alemtuzumab, ocrelizumab, ofatumumab or cladribine in relapsing remitting multiple sclerosis. BMJ Open. 2024. doi:10.1136/bmjopen-2023-083582.
- MAVENCLAD 10 mg tablets, summary of product characteristics. Merck. Electronic Medicines Compendium, accessed 5 October 2026.
Read next
- HSCT or Lemtrada for MS: how the two treatments compare
- HSCT or Ocrevus for MS: how the two treatments compare
- What are the side effects of HSCT for MS?
- Can MS come back after HSCT?
- Who is eligible for HSCT at HSCT Hospital India?
- HSCT for multiple sclerosis
- Why patients choose HSCT Hospital India
- MS patients from the USA on HSCT in India
- A guided video tour of HSCT in India
Why Choose HSCT Hospital India for Life Changing Multiple Sclerosis Treatment
Complete 30 day HSCT done in hospital. Private deluxe rooms are very well served for patient and attendant comfort and equipped with HEPA Filter with Triple Level Air Filtration. No outside hospital stay avoids risk of infection during the aplastic phase, 24 x 7 nursing care and best medical attention. Advanced HSCT protocol used does not require any further chemo or treatment after leaving the hospital. Click here to get complete details
International and Globally Renowned Accreditations. HSCT Hospital India is accredited by the Joint Commission International, USA, the National Accreditation Board for Hospitals and Healthcare Providers (NABH), and the National Accreditation Board for Laboratories (NABL) for processes and high quality patient care. Click here to know more
Real Patients, Real Stories
A Finland Patient’s Inspiring Recovery from Multiple Sclerosis after HSCT Treatment at JCI-USA Accredited World Class Hospital in India
Jukka from Finland, who has primary progressive MS, completed the full 30 day HSCT programme at HSCT Hospital India.
American Cop Flies to India for HSCT: 95% Symptom free, 5 Months after HSCT Treatment at JCI-USA Accredited World Class Hospital in India
Dylan, a US police officer with small fibre neuropathy, had about 95 per cent of his symptoms gone five months after HSCT.
Sergel, 38M from Holland: Multiple Sclerosis Patient shares after HSCT Treatment at JCI-USA Accredited World Class Hospital in India
Watch this Video testimonial: Sergel, 38 years young man from Netherlands suffering from Multiple Sclerosis
