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From the Services of Neurology (Drs. Saiz and Graus), Bone Marrow Transplantation Unit (Drs. Carreras, Martinez, and Rovira), Hematology, Radiology (Drs. Berenguer and Pujol), Immunology (Dr. Yague), and Blood Bank (Dr. Marin), Hospital Clínic, Institut d’Investigació Biomèdica August Pi i Sunyer (IDIBAPS), University of Barcelona; and Service of Neurology (Dr. Arbizu), Unidad de Esclerosis Múltiple, C.S.U. de Bellvitge, L’Hospitalet, Spain.
Address correspondence and reprint requests to Dr. Francesc Graus, Service of Neurology, Hospital Clínic. Villarroel 170, 08036 Barcelona, Spain; e-mail:graus{at}medicina.ub.es
OBJECTIVE: To analyze the MRI and CSF oligoclonal bands (OB) changes in patients with MS who underwent an autologous hematopoietic stem cell transplantation (AHSCT).
BACKGROUND: AHSCT is evaluated as an alternative therapy in severe MS. In previous series of AHSCT for MS, data on MRI or OB outcome were limited or not provided.
METHODS: Five patients with a median Kurtzke’s EDSS score of 6.5, more than two attacks, and confirmed worsening of the EDSS in the previous year received an AHSCT. Hematopoietic stem cells were mobilized with cyclophosphamide (3 g/m2) and granulocyte colony-stimulating factor (5 µg/kg/d). The graft was T cell depleted by positive CD 34+ selection. Conditioning regimen included BCNU (300 mg/m2), cyclophosphamide (150 mg/kg in 3 days), and antithymocyte globulin (60 mg/kg in 4 days). MRI scans were scheduled at baseline and 1, 3, 6, and 12 months and OB analysis at baseline and 3 and 12 months post-AHSCT.
RESULTS: Four patients had a stable or improved EDSS after a median follow-up of 18 months (range, 12 to 24 months). The fifth patient’s condition deteriorated during AHSCT. She partially improved and remained stable after month 3 after AHSCT. The baseline CSF OB persisted 1 year after AHSCT. MRI studies after AHSCT showed no enhanced T1 lesions and no new or enlarging T2 lesions. The median percentage change of T2 lesion load was -11.8% (range, -26.6 to -4.0%). All patients had a decrease of corpus callosum area at 1 year (median, 12.4%; range, 7.8% to 20.5%) that did not progress in the two patients evaluated at 2 years after AHSCT.
CONCLUSIONS: Although the persistence of CSF OB suggests the lymphocytes were not eliminated from the CNS, the follow-up MRI studies showed no enhanced T1 brain lesions and a reduction in the T2 lesion load that correlated with the clinical stabilization of MS after AHSCT.
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