A Three-Year Study of Brain Atrophy after Autologous Hematopoietic Stem Cell Transplantation in Rapidly Evolving Secondary Progressive Multiple Sclerosis

Università degli Studi di Genova, Genova, Liguria, Italy
American Journal of Neuroradiology (Impact Factor: 3.59). 11/2007; 28(9):1659-61. DOI: 10.3174/ajnr.A0644
Source: PubMed


In multiple sclerosis (MS), autologous hematopoietic stem cell transplantation (AHSCT) induces a profound suppression of clinical activity and MR imaging-detectable inflammation, but it may be associated with a rapid brain volume loss in the months subsequent to treatment. The aim of this study was to assess how AHSCT affects medium-term evolution of brain atrophy in MS.
MR imaging scans of the brain from 14 patients with rapidly evolving secondary-progressive MS obtained 3 months before and every year after AHSCT for 3 years were analyzed. Baseline normalized brain volumes and longitudinal percentage of brain volume changes (PBVCs) were assessed using the Structural Image Evaluation of Normalized Atrophy software.
The median decrease of brain volume was 1.92% over the first year after AHSCT and then declined to 1.35% at the second year and to 0.69% at the third year. The number of enhancing lesions seen on the pretreatment scans was significantly correlated with the PBVCs between baseline and month 12 (r = -0.62; P = .02); no correlation was found with the PBVCs measured over the second and third years.
After AHSCT, the rate of brain tissue loss in patients with MS declines dramatically after the first 2 years. The initial rapid development of brain atrophy may be a late consequence of the pretransplant disease activity and/or a transient result of the intense immunoablative conditioning procedure.

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Available from: Peter A W te Boekhorst
    • "In an experimental autoimmune encephalitis (EAE) model, cortical atrophy correlated with disease duration when cerebellar white matter lesions were detected at an early time point, demonstrating that myelin-specific autoimmune responses can lead to brain atrophy in an otherwise normal CNS (MacKenzie- Graham et al., 2006). However, local atrophies (for example, of the thalamus) may be observed in MS for unknown reasons (Houtchens et al., 2007), and atrophic process in MS can improve with stem cell transplantation (Rocca et al., 2007). "

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    • "This rate remains essentially constant and high throughout the course of MS, from clinically isolated syndrome (CIS) to PP-MS [3] [4]. Interestingly, even in the RR-MS phase treated by the most active treatments for preventing relapses, i.e. alemtuzumab or autologous stem cell transplantation, the brain atrophy rate decreases but always fails to normalize and remains high [5] [6] [7] [8]. "
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