Authors
Nikolaev I.S. 1, Shamtieva K.V.2, Pugachev A.Y.3, Melnichenko V.Y.1, Fedorenko D.A.1
1 Pirogov National Medical and Surgical Center, Moscow
2 Scientific center of neurology, Moscow
3 «Family» Clinic, Moscow
Abstract
Background of the study: for more than 20 years, high-dose immunosuppressive therapy (HIST) with autologous hematopoietic stem cell transplantation (autoHSCT) has been successfully used in the world to stop the progression of multiple sclerosis (MS). The effectiveness of this therapy has been proven in many multicenter randomized trials. However, data on the outcomes of such treatment in the early post-transplant period (up to three months) in the world literature is not enough.
Objective: to evaluate the early neurological outcomes of HIST followed by autoHSCT in patients with relapsing-remitting multiple sclerosis (RRMS).
Methods: the study included 20 patients with significant RMS (McDonald 2017). Among them, 6 men and 14 women aged 19 to 51 years (median 34.2±9.6 years) who underwent VIST (R-Cph 200) followed by autoHSCT. The follow-up period ranged from 31 to 34 days (median 31.45 days). At both points of the study, the neurological status was assessed according to the Scripps neurologic rating scale (SNRS), the score on the extended Kurtzke disability scale (EDSS), MRI of the brain and spinal cord with contrast, the presence of spasticity in the paretic limbs according to the modified Ashworth scale (MAS).
Results. After treatment, significant differences were obtained for both EDSS (p = 0.0001) and SNRS (p=0.00004). Improvement on the EDSS scale averaged 0.5 points [0; 1] in 13 patients (65%). According to the SNRS scale — 5 points [3; 9] in 19 patients (95%). The disappearance of contrast accumulation was noted in three patients (30%), however, in one (10%), an accumulation of a contrast agent was detected, which was not previously observed. The presence of negative dynamics according to the EDSS and SNRS scales was not observed in this patient. In 6 (75%) patients, a decrease in the severity of the increase in pyramidal tone according to MAS was revealed by at least 1 point.
Conclusion. HIST with autoHSCT can improve the performance of the neurological rating scale and the extended disability scale even in the early post-transplant period. For a more accurate assessment of the effectiveness of treatment, it is preferable to evaluate the dynamics on the SNRS scale due to its complexity and completeness of the indicators used. Absence of accumulation of a contrast agent during MRI in the early stages after treatment was detected in 30% of cases. In 75% of patients, a decrease in spasticity by 1 point on the MAS scale was noted 2 weeks after VIST with autoHSCT.
Keywords: relapsing-remitting multiple sclerosis, HIST+autoHSCT, autologous hematopoietic stem cell transplantation. Autologous hematopoietic stem cell transplantation, HSCT.
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