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Old 09-11-2019, 02:00 PM
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This study found more benefit for aHSCT... -D

Efficacy of aHSCT and Alemtuzumab: A Case-Control Study in Hamburg MS-patients

V. Häußler1, J.-P. Stellmann1, J. Pöttgen1, C. Wolschke2, M.A. Friese1, C. Heesen1, N. Kröger2 1Institute of Neuroimmunology and Multiple Sclerosis, 2Department of Stem Cell Transplantation, University Medical Center Hamburg-Eppendorf, Hamburg, Germany

Introduction: Autologous stem cell transplantation (aHSCT) is increasingly recognized as a therapy in highly inflammatory multiple sclerosis (MS). Recently, a randomised-controlled trial showed promising results with no progression in relapsing-remitting MS in 98 % of the patients within the first 2 years after treatment. Alemtuzumab, one of the currently most effective approved therapies, reached a maximal proportion of progression free patients of 78% in the pivotal trial.

Objectives: To assess differences in disease activity in highly inflammatory MS patients treated with aHSCT or alemtuzumab.
Methods: We performed a prospective Case-Control-Study observing clinical course (EDSS and relapses), MRI parameters (new T2 lesions) and neuropsychological assessment in 40 patients with MS receiving either aHSCT or alemtuzumab between 2007 and 2018 at our centre. We used survival analyses to compare the primary outcome “No Evidence of disease activity” (NEDA) as defined by no EDSS progression, no relapse and no new T2 lesion on MRI.

Results: 19 patients, of which 12 showed relapsing-remitting MS and 7 progressive MS with on-going high inflammatory activity, were treated with aHSCT, whereas 5 of the 21 patients with alemtuzumab suffered from an underlying chronic disease course. There were no significant differences regarding disease course, sex (63%/66% female), age (mean(SD) 35.1(10.0)/37.9(9.9) years), EDSS (4.7(1.9)/4.9 (1.85)), or number of prior immunotherapies (2.3(1.2)/2.8(1.5)). However, disease duration was significantly longer in the alemtuzumab group (5.4 (4.2)/11.3(6.8) years) and relapse activity 2 years prior to the initiated therapy (1.8(2.0)/1.0(1.0)) tended to be lower. Follow-up time was 58.8 (36.0) months in the aHSCT group compared to 25.2(12.0) months in the alemtuzumab treated patients. We observed significantly more patients fulfilling NEDA in the aHSCT group (0.48/0.35, p = 0.048) compared to the alemtuzumab treated patients. Confirmed EDSS progression was not different between groups.

Conclusion: This case-control study suggests that aHSCT suppresses inflammatory activity in MS more effectively than alemtuzumab. Despite longer disease duration and lower pre-treatment relapse activity in the alemtuzumab group, which hypothetically should be associated with less inflammatory activity, more MRI activity and relapses were observed in this group in comparison to aHSCT treated patients.
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