Patients with poor-prognosis multiple sclerosis (MS) who underwent chemotherapy-based immune ablation, followed by immune reconstitution with an autologous hematopoietic stem cell transplant, showed early acceleration of brain atrophy but no new inflammatory activity, according to a recent study. Researchers calculated percentage whole-brain volume changes in a cohort of 19 patients, between the baseline and follow-up magnetic resonance imaging (MRI) (mean duration, 5 years). They found:

• Treatment was followed by accelerated whole-brain volume loss averaging 3.3%.

• Both the cancer drug dose and the baseline lesion volume were significant predictors.

• The atrophy slowed progressively over approximately 2.5 years.

• There was no evidence that resolution of edema contributed to volume loss.

• The mean rate of long-term atrophy was -0.23% per year, consistent with the rate expected from normal aging, suggesting that stopping inflammatory activity in MS can reduced secondary degeneration and atrophy.

Citation: Lee H, Narayanan S, Brown RA, Chen JT, et al. Brain atrophy after bone marrow transplantation for treatment of multiple sclerosis. [Published online ahead of print May 31, 2016]. Mult Scler J. doi:10.1177/1352458516650992.