What eligibility criteria usually exclude people from aHSCT MS trials?

The short version: the trials are built to exclude the people who most need a real answer, and the records here barely name the criteria at all.

The honest limit first: none of these records lists a trial's inclusion or exclusion criteria. The MIST and ASTIMS trials are described only by disease type and size, not by who was screened out [1]. So I can tell you the shape of the funnel from what the records do show, not from a criteria list.

What the records establish is who got in. MIST enrolled relapsing-remitting MS and compared transplant against standard drugs [1]. ASTIMS enrolled active inflammatory disease [1]. The pooled data that show benefit are concentrated in relapsing-remitting patients: about 83 in 100 free of disease activity at two years, about 67 in 100 at five [1]. The same review says evidence for progressive MS and long-term outcomes remains limited [1]. That is the real filter. Progressive disease is where the benefit is unproven, so trials narrow to the relapsing group most likely to look good.

The other exclusions are the ones any transplant requires. You need enough stem cells collected, and the records treat a minimum CD34 count per kilogram as the predictor of engraftment [2]. You need a body that can survive the conditioning chemo. One cardiac study excluded people with existing heart disease and high blood pressure before high-dose chemo [3]. Older age, other autoimmune disease, active infection, and prior heavy treatment are the usual walls, but this retrieval does not give me the exact cutoffs, and I will not invent them.

My call: the criteria that matter most are disease type (relapsing favored, progressive excluded or understudied) and fitness for intensive chemo; the precise thresholds are not in these records and belong in the trial protocol itself. Confidence: low on the specific criteria, moderate on the pattern.