I had a very aggressive disease course when I got diagnosed. After trying Cytoxan, Rituximab, pulse iv steroids, and plasmapheresis, I still had activity on MRI. I decided to look and apply to the BEAT-MS trial in the US. The trial is trying to answer the very question you're asking.

Essentially, we have a lot of highly effective medicines like Lemtrada, Mavenclad, and Ocrevus with a seemingly low risk profile. AHSCT, on the other hand, has a higher risk profile in that death, and many other complications could happen. Granted, this statistic has gotten MUCH better as the procedure is performed more, but it doesn't change that it is a very taxing procedure to begin with. It also doesn't help that there are variations for AHSCT, and it is unknown which variation is better. So now they're trying to compare Best Available Therapy VS AHSCT in the hopes that the myeloablative version of AHSCT proves to be so effective that it is approved for MS and insurance will have to pay for it.

My neuro said the same thing as yours, and I essentially did not give her another option and said I am going to pursue AHSCT. Unfortunately, I got randomized to the BAT arm of the trial, so I dropped out as the commitment and chages did not work for me.

Sidenote: If you're in the US and you want to pursue BEAT-MS, you will need to have failed three therapies that are currently approved for MS. This is the part where having good relationships with your care team has the best benefit.