HSCT or Ocrevus 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: 29 September 2026. This guide cites peer-reviewed studies, which are listed at the end.

Ocrevus is the brand name of ocrelizumab, a medicine for multiple sclerosis that has been approved in the United States since 2017. It is given as an infusion into a vein every six months, and it keeps working for as long as the infusions continue. HSCT, short for autologous haematopoietic stem cell transplantation, is a single course of treatment. 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.

Both treatments act on the immune system, and both are counted among the most effective options for relapsing MS. The main difference is how each treatment is given. Ocrevus is an ongoing medicine taken near home. HSCT is one hospital stay followed by recovery and check ups, with no ongoing MS medicine for most patients.

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, and there is no long waiting list.

How do Ocrevus and HSCT work on my immune system?

Ocrevus and HSCT both target the white blood cells that drive MS, but they reach them in different ways. In MS, these immune cells damage myelin, the protective coating around the nerves of the brain and spinal cord. Damage to myelin disturbs the signals that control sight, movement and feeling.

Ocrevus is a monoclonal antibody, which is a protein made in a laboratory to attach to one chosen target. Its target is a marker called CD20, found on the surface of B cells. B cells are one type of white blood cell, and Ocrevus removes most of them from your blood after each infusion. Because your body keeps making new B cells, the infusion is repeated every six months to keep their numbers low.

HSCT acts on more of the immune system at once. At HSCT Hospital India, chemotherapy with cyclophosphamide and ATG, short for anti-thymocyte globulin, clears both the T cells and the B cells involved in MS. Your own stem cells, collected and frozen earlier in the stay, are then returned to you. Over the following weeks and months they make new immune cells.

How do HSCT and Ocrevus compare, side by side?

Patients weighing the two treatments usually ask the same six questions. The answers are based on research published up to September 2026.

What is Ocrevus, and who is it given to?

Ocrevus was approved in the United States in 2017 for relapsing MS and for primary progressive MS. It was the first medicine approved for primary progressive MS, the form that worsens steadily from the start without clear attacks. Relapsing MS is the form in which symptoms come in attacks, called relapses, with periods of partial or full recovery between them.

The first dose is split into two infusions of 300 mg, given two weeks apart. After that, a single infusion of 600 mg is given every six months. Since 2024, a version given as an injection under the skin, taking about ten minutes, has also been approved in the United States.

Ocrevus is taken for as long as it keeps the MS under control. When the infusions stop, B cells gradually return. In the prescribing information, B cell counts took a median of 72 weeks to return after the last infusion. Half of patients took longer than that.

How well does Ocrevus work for MS?

Ocrevus was approved on the results of three randomised trials, in which patients are assigned to one treatment or another by chance. The two OPERA trials tested it in relapsing MS against interferon beta-1a, an older injected MS medicine. Patients on Ocrevus had 46 and 47 per cent fewer relapses a year.

The ORATORIO trial tested Ocrevus in primary progressive MS against a dummy treatment. Over the trial, 32.9 per cent of patients on Ocrevus had disability that got worse and stayed worse for 12 weeks, against 39.3 per cent on the dummy treatment. This means Ocrevus lowered the risk of disability getting worse over the length of the trial.

What happens during HSCT at HSCT Hospital India, compared with an Ocrevus infusion?

An Ocrevus infusion takes a few hours in a clinic, and you go home the same day. 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.

Stage one, mobilisation, uses a growth factor and a short course of chemotherapy. Together they bring stem cells out of the bone marrow, the blood-making tissue inside your bones, and into the circulating blood. Some patients notice aching bones for a few days during this stage.

Stage two is the collection, known as leukapheresis. Over several hours a cell separator draws your blood through a line and keeps the stem cells. The rest of your blood is given back, much like a long blood donation. The cells are then counted and stored frozen until they are returned.

Stage three, conditioning, is the chemotherapy itself. Cyclophosphamide and ATG run through a drip and remove the immune cells behind your MS. Fever, chills or a skin rash can come with ATG, and nurses manage these as they arise, with anti-nausea medicine given for sickness.

Stage four is reinfusion. The stored stem cells are warmed and given back into a vein through a drip. Within days they begin producing new blood cells, including the white cells that fight infection.

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. On this protocol, the European registry recorded white cells returning about 10 days after reinfusion.

The full sequence, from your first enquiry to your flight home, is on the page about how HSCT works at HSCT Hospital India.

Has HSCT been compared with Ocrevus in research?

No completed randomised trial has yet compared HSCT with Ocrevus directly. The comparisons published so far come from large patient records, in which people who chose each treatment are matched on age, disability and relapse history. These studies show how the two treatments did in everyday care.

The largest is a 2023 study in JAMA Neurology, which used the international MSBase registry and six specialist MS centres. It compared 110 patients treated with HSCT against 343 treated with ocrelizumab over three years. Both groups had very few relapses. There was about one relapse for every 11 years of follow up after HSCT and one for every 16 years on ocrelizumab. The chance of disability getting worse or getting better was also similar, and the authors found no clear difference between the two.

A 2025 study from a London hospital, published in the Annals of Neurology, compared 103 patients treated with HSCT against 314 treated with ocrelizumab. Over three years, the HSCT group had fewer relapses, 0.028 a year against 0.073 on ocrelizumab. New activity on MRI scans was equally low in both groups, at about 6 per cent, and the risk of disability getting worse was similar.

In these studies, HSCT and Ocrevus both rank among the most effective MS treatments. For a patient, the practical differences are how each is given, how long it continues and what it costs over the years.

Which trials are comparing HSCT with Ocrevus now?

Three randomised trials are testing HSCT against the most effective MS medicines, and Ocrevus is among the medicines they compare with. In the United Kingdom, the StarMS trial compares HSCT with alemtuzumab, ocrelizumab, ofatumumab and cladribine. It has 94 participants, finished recruiting in 2024, and its results are expected in 2027.

In Norway, the RAM-MS trial compares HSCT with alemtuzumab, cladribine or ocrelizumab in relapsing remitting MS. In the United States, the BEAT-MS trial compares HSCT with the best available medicine for each participant, and it is due to complete in 2029.

These trials follow 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. The HSCT given in MIST was cyclophosphamide with ATG, the same combination used at HSCT Hospital India.

Average disability scores also went in different directions. On EDSS, the 0 to 10 scale doctors use to measure MS disability, the HSCT group improved from 3.38 to 2.36 within a year. Over the same year the drug group worsened from 3.31 to 3.98.

What side effects should I expect from each treatment?

The side effects of the two treatments follow how each is given. With Ocrevus, side effects can come with every infusion for as long as it is given. With HSCT, most side effects come during the 30 day stay, while HSCT Hospital India is looking after you. They ease as your blood counts recover.

With Ocrevus, the most common side effect is an infusion reaction, such as itching, a rash, a flushed face or a sore throat. In the trials, 34 to 40 per cent of patients had one, most often with the first infusion, and medicines given beforehand lower the chance. Upper respiratory infections, such as colds and sinus infections, affected 40 per cent of patients on Ocrevus in the relapsing MS trials. Before starting, patients are tested for hepatitis B, because Ocrevus can bring back an old infection.

The prescribing information also records that breast cancer was diagnosed in 6 of 781 women on Ocrevus in the trials. None of the 668 women on the comparison treatments had it. For this reason, women on Ocrevus are advised to keep up with their usual breast screening.

With HSCT, the side effects come mainly from the chemotherapy. Hair loss is expected, and hair usually starts growing back from about three months. Nausea is treated with anti-nausea medicine given before and during chemotherapy, and tiredness eases as your blood counts rise. The main risk is infection while your immunity is low. For this reason the whole stay is in-patient, in a Triple HEPA filtered room, and medicines to prevent infection continue after you go home.

Cyclophosphamide can also affect fertility. For this reason, fertility preservation is discussed with you before treatment begins. In the MIST trial, no patient died, and none of the patients who had HSCT developed a life-threatening complication outside the blood system.

I am on Ocrevus now. Can I still have HSCT?

Yes, patients who are taking Ocrevus, or who have taken it before, are reviewed for HSCT. Many patients reviewed at HSCT Hospital India have already tried one or more MS medicines, as the 36 year old patient from the United Kingdom had. 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 date of your last infusion as part of your records. They then advise you on how Ocrevus fits with the timing of your HSCT. You should not stop Ocrevus on your own, and the decision is made together with your neurologist at home.

Some patients consider HSCT because their MS has stayed active on Ocrevus, with new relapses or new lesions on MRI. Lesions are areas of damage to myelin that show up on the scan. Others choose it because they want one course of treatment rather than an infusion every six months for many years. Each case is reviewed on its own records.

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. It is aimed at the immune cells producing that activity, so it suits people whose MS stays active on medicine, including on Ocrevus.

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. Secondary progressive MS begins as relapsing MS and later worsens steadily, and for every form the doctors check whether the scans still show inflammation.

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.

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 cost is agreed before you book travel. One all-inclusive payment of US $30,000 covers the treatment, up to 30 days in hospital, food and laundry for both you and your attendant, and 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. Prices in other countries are compared on the page about HSCT cost by country.

What do patients treated at HSCT Hospital India say about their HSCT?

Patients from the United Kingdom and Suriname have described their treatment at HSCT Hospital India on video, and the results they describe are their own.

A 36 year old man from the United Kingdom came to HSCT Hospital India with problems in his vision, spasticity and pain. Spasticity is stiffness and tightness in the muscles. He travelled alone, so the hospital arranged a private nurse for him.

“I was having issues with my vision, and I was having issues with spasticity and pain.” MS patient from the United Kingdom, aged 36

“They did a lot of tests. They went through everything. They were quite thorough.” MS patient from the United Kingdom, aged 36

“They put my stem cells back in to help my body. Right after, [I] have got better.” MS patient from the United Kingdom, aged 36

His full account is on the page about a 36 year old MS patient from the United Kingdom. Rohini from Suriname was diagnosed with relapsing remitting MS in 2017 and came to HSCT Hospital India once she saw her MS getting worse.

“I was diagnosed with RRMS in 2017, and after I noticed that I became worse, I thought about stem cell [treatment].” Rohini, Suriname

“I did the stem cell, [and] within two weeks I get my life back.” Rohini, Suriname

Her full account is on the page about Rohini from Suriname. More accounts from patients in the United States, the United Kingdom and Europe 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. You also take home a discharge summary, the full record of your treatment, for your own doctor or neurologist.

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 stage by stage.

Your neurologist at home continues to see you, and the results are shared with HSCT Hospital India. If your MS becomes active again, a treatment plan is agreed with your neurologist, and it can include restarting an MS medicine such as Ocrevus.

How do the costs of HSCT and Ocrevus compare over the years?

The costs of the two treatments build up in different ways. 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.

Ocrevus is paid for with every infusion, for as long as it is given. Depending on where you live, the cost is met by you, your insurer or your health service. It continues each year the medicine is used. Your insurer or MS clinic can tell you what Ocrevus costs under your own plan.

Answers to Frequently Asked Questions (FAQs) about HSCT and Ocrevus for MS

Is HSCT better than Ocrevus for MS?

No randomised trial has compared them directly yet. Studies of patient records found both keep relapses low, with HSCT showing fewer relapses in one London study and no clear difference in a larger registry study.

Can I have HSCT if I am taking Ocrevus?

Yes, patients on Ocrevus are reviewed for HSCT. The HSCT specialist doctors look at the date of your last infusion and advise you, together with your neurologist, on how it fits with the timing of your treatment.

Is Ocrevus a form of chemotherapy?

No, Ocrevus is a monoclonal antibody, a laboratory-made protein that removes B cells. HSCT uses chemotherapy, given once, during the conditioning stage of the stay.

How often is Ocrevus given?

Ocrevus is given as an infusion every six months, after a first dose split into two infusions two weeks apart. Treatment continues for as long as it keeps your MS under control.

Does Ocrevus work for progressive MS?

Ocrevus is approved for primary progressive MS, where the ORATORIO trial found it lowered the risk of disability getting worse. HSCT Hospital India also assesses progressive MS for HSCT, and the deciding question is whether recent scans show inflammation.

Do I need to keep taking Ocrevus after HSCT?

Most patients need no MS medicine after HSCT. If your MS becomes active again later, your neurologist can restart a medicine, and Ocrevus can be one of the options.

Which costs more over time, HSCT or Ocrevus?

HSCT at HSCT Hospital India is one all-inclusive price of US $30,000. Ocrevus is paid for with every infusion for as long as it is given, so its cost depends on your country and your insurance.

Does HSCT cause infertility?

Cyclophosphamide can affect fertility. Fertility preservation is discussed with you before treatment begins, so that you can plan for it.

Can a family member stay with me in India?

Yes, your attendant shares your private room for the whole stay. Their food and laundry are part of the one price.

This page was medically reviewed on 29 September 2026 against the published research listed below.

References

1. 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. PMID 30644983.
2. Kalincik T, Sharmin S, Roos I, et al. Comparative effectiveness of autologous hematopoietic stem cell transplant vs fingolimod, natalizumab, and ocrelizumab in highly active relapsing-remitting multiple sclerosis. JAMA Neurology. 2023;80(7):702-713. PMID 37437240.
3. Muraro PA, Zito A, Signori A, et al. Effectiveness of autologous hematopoietic stem cell transplantation versus alemtuzumab and ocrelizumab in relapsing multiple sclerosis: a single center cohort study. Annals of Neurology. 2025;98:294-307. PMID 40251896.
4. OCREVUS (ocrelizumab) prescribing information. Genentech, South San Francisco.
5. Greco R, Saccardi R, Ponzano M, et al. BEAM/ATG or cyclophosphamide/ATG as conditioning regimen in autologous haemopoietic stem cell transplantation for multiple sclerosis. Bone Marrow Transplantation. 2025. PMID 41023426.
6. HSCT research evidence: StarMS, RAM-MS and BEAT-MS. MS Society UK, accessed September 2026.

Read next

• Can MS come back after HSCT?
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• Which HSCT protocol is best for MS?
• HSCT for progressive MS
• Who is eligible for HSCT at HSCT Hospital India?
• What are the side effects of HSCT for MS?
• HSCT for multiple sclerosis

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