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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 0–8), 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.
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 0–8), 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.