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.
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. HSCT uses chemotherapy to remove the immune cells behind the nerve damage of MS, then gives back the patient’s own stem cells so the immune system can be rebuilt.
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.
Since 2016, HSCT Hospital India has treated over 1,500 MS patients who travelled from more than 30 countries. The hospital follows the non-myeloablative protocol developed by Dr Richard Burt and holds JCI-USA, 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 injure myelin, the sheath that protects the nerves in the brain and spinal cord. This disrupts the nerve signals that control vision, movement and sensation.
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 works on the immune system differently. Chemotherapy at HSCT Hospital India uses cyclophosphamide and ATG (anti-thymocyte globulin) to clear the T cells and B cells that drive your MS. The stem cells collected and frozen earlier in your stay are then returned to your bloodstream. The new immune cells come from these stem cells, and most patients need no MS medicine afterwards.
How do HSCT and Mavenclad compare, side by side?
Six questions come up most often when patients compare Mavenclad with HSCT. 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 takes place in New Delhi during one hospital stay that lasts up to 30 days. | It is taken as tablets at home, in two treatment weeks a year for two years. |
| What follow up does it need? | In the first months your blood is tested often, and regular check ups follow. | Blood counts are checked before each treatment year and two and six months after it starts. |
| What does it act on? | It removes the T cells and B cells involved in MS, after which your own stem cells make 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? | Most are brief, caused by the chemotherapy, and treated on the ward as they occur. | A low lymphocyte count is expected, and shingles is more common than on placebo. |
| What does it cost? | A single all-inclusive price of US $30,000 pays for the entire 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 means symptoms flare in episodes called relapses, followed by partial or full recovery.
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. Being randomised means that chance, not the doctor or the patient, decided which treatment each person received. 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. The HSCT programme is a single in-patient stay of up to 30 days, and your attendant lives in your private room with you. A full medical evaluation comes first, and the four stages of treatment follow in a fixed sequence.
Mobilisation, collection, conditioning and reinfusion are the four stages. In the first two stages, a growth factor and a short chemotherapy course release stem cells from the bone marrow into the bloodstream. Over several hours a machine gathers them from your blood, much like a blood donation, and they are frozen for later use.
Conditioning means chemotherapy with cyclophosphamide and ATG, given by drip over several days. While ATG is running it can cause fever, chills or a rash, and the nurses treat each as it appears. The frozen stem cells are thawed and given back by drip, and within days they begin making new blood cells.
Your white cell count drops very low in the days following reinfusion, the period doctors call the aplastic phase. Patients remain in hospital at HSCT Hospital India for the whole of this period. Triple HEPA air filtration protects your private room, and round the clock nursing means a fever is treated as soon as it starts.
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. An HSCT Case Manager writes to you with the doctors’ opinion, and their review costs nothing.
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 assigned 110 people with relapsing MS at random to HSCT or to the MS medicines in use at that time. After HSCT, 3 of 52 people saw their disability worsen, compared with 34 of 51 who remained 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 two treatments cause side effects at different points. With HSCT, side effects mostly occur during the 30 day stay, when HSCT Hospital India is caring for 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.
HSCT side effects come mostly from the chemotherapy and from the weeks when immunity is low. Hair falls out during treatment and usually starts to come back after about three months. Anti-nausea medicine treats sickness, and tiredness lifts as your blood counts recover.
While immunity is low, infection is the main risk, and fevers are common. 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. You continue taking medicines to prevent infection once you are home.
Cyclophosphamide can affect fertility. Before treatment starts, you can discuss fertility preservation with the doctors. Further detail is on the page about the side effects of HSCT for MS.
Patients who have taken Mavenclad tablets can request the HSCT Hospital India brochure by email. It explains the 30 day stay in New Delhi and what the single price covers.
I have taken Mavenclad. Can I still have HSCT?
Yes, patients who have taken Mavenclad are reviewed for HSCT. Many of the patients HSCT Hospital India reviews have already used one or more MS medicines. Two things decide your case: whether your MS is still active, and whether HSCT is likely to benefit 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. Your neurologist at home is part of the decision.
How does HSCT Hospital India review a patient who has taken Mavenclad?
A multi-disciplinary team of HSCT specialists at HSCT Hospital India reviews every referral before a decision is made. The specialists read the EDSS your neurologist recorded, your MRI scans in date order and your history of relapses. For a patient who has taken Mavenclad, this shows whether MS activity has returned since the last treatment year.
There is no fee for the review and no commitment to go ahead. Your HSCT Case Manager sends you the doctors’ opinion personally and takes your questions about the stay. With no long waiting list, an accepted patient can plan a treatment date without delay.
Send your diagnosis, your latest MRI report and the dates of your Mavenclad treatment weeks through the enquiry form. No fee is charged for the specialist review, and the reply arrives by email from an HSCT Case Manager.
Whose MS is HSCT at HSCT Hospital India most likely to help?
HSCT is most effective while MS is still inflammatory, that is, with relapses or new or enlarging MRI lesions in the past year. On an MRI, lesions are visible areas where myelin has been damaged. This is the same group of patients Mavenclad is given to.
Patients up to about 60 years of age with an EDSS no higher than 6.5 are reviewed by HSCT Hospital India. An EDSS of 6.5 usually means walking with two sticks or a similar aid. People with relapsing remitting, secondary progressive or primary progressive MS can all apply.
Patients above 60, or with an EDSS above 6.5, are still looked at individually, and the doctors explain their scans to them. 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?
When HSCT is the treatment you choose, the next step is deciding where. Over 1,500 people with MS from more than 30 countries have been treated at HSCT Hospital India since 2016. The hospital’s JCI-USA accreditation is an international mark of quality and patient safety, and it is also accredited by NABH and NABL.
HSCT Hospital India works to Dr Richard Burt’s non-myeloablative protocol, the approach tested in the MIST trial. With non-myeloablative chemotherapy, the bone marrow is weakened but not destroyed. This is why blood counts come back sooner, and after discharge you need no more chemotherapy or MS treatment.
Infection control shapes how the ward is run. Throughout treatment you are in a deluxe private room with Triple HEPA air filtration. Nurses are on hand at all hours, and your attendant is with you throughout. Neuro-physiotherapy continues through the stay, with a physiotherapist setting exercises to build your strength and balance.
You spend the full 30 days of treatment in the hospital itself, not in an outside hotel or apartment. It matters most in the aplastic phase, when immunity is at its lowest. Because nurses work 24 hours a day, a fever during that time is dealt with immediately.
The price is fixed before you arrange your travel. Pre-testing, the MRI, the full HSCT treatment and up to 30 days in hospital are all paid for by one payment of US $30,000. Doctors’ fees, tests and consultations, medicines, consumables and physiotherapy are covered as well. Meals and laundry for you and your attendant are included, as are airport pick-up and drop-off. Your HSCT Case Manager helps with the Indian medical visa and stays in touch with you until your flight home.
Travelling to New Delhi raises questions about flights, the Indian medical visa and bringing a family member. Your HSCT Case Manager can call you to talk them through at no cost.
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?
No further chemotherapy is taken once you leave India, and most patients need no MS medicine afterwards. Two documents go home with you. Your Discharge Summary sets out the treatment you received, for your own GP or neurologist to read. Your Aftercare Manual sets out your medicines, your blood test timetable and when you can return to normal activities.
After you return home, your blood results are sent to HSCT Hospital India. The HSCT specialists who treated you keep following your recovery, and your neurologist can ask them any question.
Your counts are tested twice a month for two months, and monthly after that until they are back to normal. Normal activities usually return within 2 to 4 months. Most people recover fully within 3 to 12 months, and the page about recovery time after HSCT for MS sets out each stage.
How do the costs of HSCT and Mavenclad compare?
Payment is made once: US $30,000, all inclusive, for the treatment and the 30 day stay at HSCT Hospital India. Expect to pay separately for your travel to New Delhi and for check ups at home. 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 is free of charge and carries no obligation, and an HSCT Case Manager answers you in person.
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. The chemotherapy at HSCT Hospital India is cyclophosphamide with ATG, the same combination given 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. The 30 day in-patient stay in New Delhi covers all four stages: mobilisation, collection, conditioning and reinfusion. Once treatment is over, you do not need more chemotherapy, and in most cases no MS medicine either.
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 final timing is agreed 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 the side effects are concentrated in the first weeks, when immunity is low, and HSCT Hospital India keeps you in hospital in a Triple HEPA filtered private room for that time. 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. For these patients, HSCT Hospital India reviews those aged up to about 60 with an EDSS of 6.5 or less. If you fall outside these limits, your case is still considered on its own, with the doctors explaining what your scans show.
How do the costs of HSCT and Mavenclad compare?
At HSCT Hospital India, HSCT costs one all-inclusive US $30,000. Pre-testing, MRI, the complete treatment, up to 30 days in hospital, food and laundry for you and your attendant, and airport transfers are all covered. 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 stays in your deluxe private room at HSCT Hospital India for the full stay. Your attendant’s food and laundry are included in the US $30,000 price. Visa paperwork is part of what your HSCT Case Manager handles for you.
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.
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- 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
