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Continued Disease Activity in a Patient With Multiple Sclerosis After Allogeneic Hematopoietic Cell Transplantation
Jian-Qiang Lu, MD, PhD;
Jan Storek, MD, PhD;
Luanne Metz, MD;
V. Wee Yong, PhD;
Anne M. Stevens, MD, PhD;
Richard A. Nash, MD;
Jeffrey T. Joseph, MD, PhD
Arch Neurol. 2009;66(1):116-120.
Objective To examine the effect of allogeneic hematopoietic cell transplantation (HCT) on disease activity in a patient with multiple sclerosis (MS).
Design Case report, prospective study, and autopsy.
Setting Departments of Clinical Neurosciences, Internal Medicine, and Pathology at the University of Calgary, Alberta, Canada.
Patient A 39-year-old woman with chronic myelogenous leukemia and concurrent mild MS.
Interventions Hematopoietic cell transplantation from a healthy unrelated donor.
Results After HCT the patient developed graft-vs-host disease and experienced worsening, but not new, neurological symptoms. Her circulating leukocytes were 100% of donor origin. Magnetic resonance imaging showed increased lesion burden. She died of adenovirus hepatitis 20 weeks after HCT. An autopsy revealed demyelinating-inflammatory activity in active lesions and chronic active lesions.
Conclusion Despite high-dose, cytotoxic, immunosuppressive therapy and exchange of a presumed autoreactive immune system with a healthy immune system, MS in this patient continued to be active.
Author Affiliations: Departments of Pathology (Drs Lu and Joseph), Internal Medicine (Dr Storek), and Clinical Neurosciences (Drs Metz and Yong), University of Calgary, Alberta, Canada; Department of Pediatrics, University of Washington and Center for Immunity and Immunotherapy, Children's Hospital Research Institute (Dr Stevens); and Fred Hutchinson Cancer Research Center, Seattle, Washington (Dr Nash).
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