Patient description: The patient is a 20 year old Caucasian female presents to the clinic with one-sided vision lost and facial weakness, dysarthria and numbness lasting for 1 day. She visited her PCP and underwent brain MRI which revealed a single plaque in the brainstem. After few months, she experienced lower extremities weakness led to balance problem. The second MRI revealed another lesion in the left cerebral hemisphere. The diagnosis of Relapsing Remitting Multiple Sclerosis (RRMS) is confirmed after the second MRI. Her past surgical history is significant for a C-section 2 years ago and she has a one child. She is divorced and is not currently in any sexual relationship. She smokes 10 cigarettes per day and drinks alcohol occasionally. She is working as an editor in a publisher company and she is happy that she can keep working from home most of the time. She is under the treatment of RRMS from 7 months ago.

Clinical trial eligibility criteria: eligible ages (years): 18.0-55.0,  Relapsing Multiple Sclerosis Relapsing Remitting Multiple Sclerosis Secondary Progressive Multiple Sclerosis Participant(s) must meet all of the following to be eligible for this study: 1. Diagnosis of Multiple Sclerosis (MS) according to the 2017 McDonald 2. (Kurtzke) Expanded Disability Status Scale (EDSS) ≥ 2.0 and ≤ 5.5 at the time of randomization (Day 0) 3. T2 abnormalities on brain Magnetic Resonance Imaging (MRI) that fulfill the 2017 McDonald MRI for dissemination in space --A detailed MRI report or MRI images must be available for review by the site neurology investigator. 4. Highly active treatment-resistant relapsing MS, defined as ≥ 2 episodes of treatment failure in the 24 months prior to the screening visit (Visit -2). as described below: 1. Each episode of treatment failure must occur following ≥ 3 months of treatment with an FDA-approved Disease-modifying Therapy (DMT) for relapsing forms of MS, or with rituximab, and 2. At least one episode of treatment failure must occur with an oral agent or a monoclonal antibody, specifically: dimethyl fumarate (Tecfidera®), teriflunomide (Aubagio®), cladribine (Mavenclad®), daclizumab (Zinbryta®), siponimod (Mayzent®), fingolimod (Gilenya®), rituximab (Rituxan®), ocrelizumab (Ocrevus®), natalizumab (Tysabri®), or alemtuzumab (Campath®, Lemtrada®), and 3. At least one episode of treatment failure must have occurred within the 12 months prior to the screening visit (Visit -2), and 4. At least one episode of treatment failure must be a clinical MS relapse (see item d.i. below). The other episode(s) must occur at least one month before or after the onset of the clinical MS relapse, and must be either another clinical MS relapse or MRI evidence of disease activity (see item d.ii. below): i. Clinical MS relapse must be confirmed by a neurologist's assessment and documented contemporaneously in the medical record. If the clinical MS relapse is not documented in the medical record, it must be approved by the study adjudication committee, and ii. MRI evidence of disease activity must ≥ 2 unique active lesions on a brain or spinal cord MRI. A detailed MRI report or MRI images must be available for review by the site neurology investigator. A unique active lesion is defined as either of the following A gadolinium-enhancing lesion, or A new non-enhancing T2 lesion compared to a reference scan obtained not more than 24 months prior to the screening visit (Visit -2). 5. Candidacy for treatment with at least one of the following high efficacy DMTs: natalizumab, alemtuzumab, ocrelizumab, and/or rituximab. --Note: Rituximab and ocrelizumab are considered equivalent for candidacy.Candidacy for treatment for each DMT is defined as meeting all of the following No prior treatment failure with the candidate DMT, and No contraindication to the candidate DMT, and No treatment with the candidate DMT in the 12 months prior to screening. 6. Insurance or public funding approval for MS treatment with at least one candidate DMT, and 7. Ability to comply with study procedures and provide informed consent, in the opinion of the investigator  Subject(s) who meet any of the following will not be eligible for this study: 1. Diagnosis of primary progressive Multiple Sclerosis (MS) according to the 2017 McDonald 2. History of neuromyelitis optica or anti-myelin oligodendrocyte glycoprotein (anti-MOG) antibodies associated encephalomyelitis 3. Prior treatment with an investigational agent within 3 months or 5 half-lives, whichever is longer 4. Either of the following within one month prior to randomization (Day 0): 1. Onset of acute MS relapse, or 2. Treatment with intravenous methylprednisolone 1000 mg/day for 3 days or equivalent. 5. Initiation of natalizumab, alemtuzumab, ocrelizumab, or rituximab between screening visit (Visit -2) and randomization (Day 0) 6. Brain MRI or Cerebrospinal fluid (CSF) examination indicating a diagnosis of progressive multifocal leukoencephalopathy (PML) 7. History of cytopenia consistent with the diagnosis of myelodysplastic syndrome (MDS) 8. Presence of unexplained cytopenia, polycythemia, thrombocythemia or leukocytosis 9. History of sickle cell anemia or other hemoglobinopathy 10. Evidence of past or current hepatitis B or hepatitis C infection, including treated hepatitis B or hepatitis C -Note: Hepatitis B surface antibody following hepatitis B immunization is not considered to be evidence of past infection. 11. Presence or history of mild to severe cirrhosis 12. Hepatic disease with the presence of either of the following: 1. Total bilirubin ≥ 1.5 times the upper limit of normal (ULN) or total bilirubin 0 times the ULN in the presence of Gilbert's syndrome, or 2. Alanine Aminotransferase (ALT) or Aspartate Aminotransferase (AST) ≥ 2.0 times the ULN. 13. Evidence of HIV infection 14. Positive QuantiFERON TB Gold or TB Gold Plus test results (e.g., blood test results that detect infection with Mycobacterium tuberculosis) Note: A Purified Protein Derivative (PPD) tuberculin test may be substituted for QuantiFERON TB Gold or TB Gold Plus test. 15. Active viral, bacterial, endoparasitic, or opportunistic infections 16. Active invasive fungal infection 17. Hospitalization for treatment of infections or parenteral (IV or IM) antibacterials, antivirals, antifungals, or antiparasitic agents within the 30 days prior to randomization (Day 0) unless clearance is obtained from an Infectious Disease specialist 18. Receipt of live or live-attenuated vaccines within 6 weeks of randomization (Day 0) 19. Presence or history of clinically significant cardiac disease including: 1. Arrhythmia requiring treatment with any antiarrhythmia therapy, with the exception of low dose beta blocker for intermittent premature ventricular contractions 2. Coronary artery disease with a documented diagnosis of either Chronic exertional angina, or Signs or symptoms of congestive heart failure. 3. Evidence of heart valve disease, including any of the following Moderate to severe valve stenosis or insufficiency Symptomatic mitral valve prolapse, or Presence of prosthetic mitral or aortic valve. 20. Left ventricular ejection fraction (LVEF) < 50% 21. Impaired renal function defined as Estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m^2 according to the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) formula 22. Forced expiratory volume in one second (FEV1) <70% predicted (no bronchodilator) 23. Diffusing capacity of the lungs for carbon monoxide (DLCO) (corrected for Hgb) < 70% predicted 24. Poorly controlled diabetes mellitus, defined as HbA1c >8% 25. History of malignancy, with the exception of adequately treated localized basal cell or squamous skin cancer, or carcinoma in situ of the cervix. -Note:Malignancies for which the participant is judged to be cured by therapy completed at least 5 years prior to randomization (Day 0) will be considered on an individual basis by the study adjudication committee. 26. Presence or history of any moderate to severe rheumatologic autoimmune disease requiring treatment, including but not limited to the following systemic lupus erythematous