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Old 05-30-2017, 12:03 PM
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Default CASE STUDY: After HSCT, highly active RRMS returned 2.5 years later

Highly active relapsing remitting multiple sclerosis following hematopoietic stem cell transplantation: a case report (P6.355)

Amanda Piquet, Laura Baldassari and M. Mateo Paz Soldan

Neurology April 18, 2017 vol. 88 no. 16 Supplement P6.355

Abstract
Objective: We report the case of a 24-year-old woman with relapsing remitting multiple sclerosis (RRMS) resistant to several disease modifying therapies (DMT) who ultimately underwent non-myeloablative hematopoietic stem cell transplantation (HSCT). After 2.5 years free of relapses and off DMT, she developed highly active disease recurrence.

Background: HSCT has been investigated as a treatment for severe multiple sclerosis (MS) with failed response to standard immunotherapy. Non-myeloablative HSCT studies report a four year relapse-free survival of 80% and progression-free survival of 87%. Another phase II clinical trial using high-dose immunosuppressive therapy with autologous HSCT demonstrated relapse-free survival of 90.9% and progression-free survival of 86.3% at three years.

Design/Methods: Case report

Results: This patient with RRMS with ongoing clinical and MRI disease activity despite therapies with interferon beta-1a, fingolimod, dimethyl fumarate and methylprednisolone and allergic reaction to natalizumab underwent non-myeloablative HSCT. Afterwards she was relapse free for 2.5 years and remained off DMT, until she had a relapse during her 35th week of pregnancy characterized by sensory symptoms and a T6 spinal level. She was found to have more than 30 enhancing lesions in the brain and spinal cord.

Conclusions: HSCT has shown success in treating patients with MS refractory to standard immunotherapy; however, here we present a case of highly active RRMS only 2.5 years after transplantation in the setting of pregnancy. A phase II trial assessing the effect of HSCT on disease activity measured by MRI has reported a median number of 2.5 lesions over a four year period (range 08), while our patient had a significant lesion burden with > 30 lesions detected on MRI. There has been one prior case report of relapsing tumefactive MS 8 years post-HSCT. To our knowledge, no case of relapse during pregnancy following HSCT has been reported previously.
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