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Old 06-30-2017, 04:23 PM
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Default STUDY: Impact of immunoablation and aHSCT gray and white matter atrophy in MS

Impact of immunoablation and autologous hematopoietic stem cell transplantation on gray and white matter atrophy in multiple sclerosis

Hyunwoo Lee, Kunio Nakamura, Sridar Narayanan, ...
First Published June 15, 2017 Research Article

Abstract

Background:
Immunoablation and autologous hematopoietic stem cell transplantation (IA/aHSCT) halts relapses, white matter (WM) lesion formation, and pathological whole-brain (WB) atrophy in multiple sclerosis (MS) patients. Whether the latter was due to effects on gray matter (GM) or WM warranted further exploration.

Objective:
To model GM and WM volume changes after IA/aHSCT to further understand the effects seen on WB atrophy.

Methods:
GM and WM volume changes were calculated from serial baseline and follow-up magnetic resonance imaging (MRI) ranging from 1.5 to 10.5 years in 19 MS patients treated with IA/aHSCT. A mixed-effects model with two predictors (total busulfan dose and baseline T1-weighted WM lesion volume T1LV) characterized the time-courses after IA/aHSCT.

Results:
Accelerated short-term atrophy of 2.1% and 3.2% occurred in GM and WM, respectively, on average. Both busulfan dose and T1LV were significant predictors of WM atrophy, whereas only busulfan was a significant predictor of GM atrophy. Compared to baseline, a significant reduction in GM atrophy, not WM atrophy, was found. The average rates of long-term GM and WM atrophy were −0.18%/year (standard error (SE): 0.083) and −0.07%/year (SE: 0.14), respectively.

Conclusion:
Chemotherapy-related toxicity affected both GM and WM. WM was further affected by focal T1-weighted lesion-related pathologies. Long-term rates of GM and WM atrophy were comparable to those of normal-aging.
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