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Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT
BACKGROUND: Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective treatment for multiple sclerosis (MS). The impact of previous long-lasting disease-modifying treatments (DMT) for safety and efficacy of AHSCT is unknown. OBJECTIVE: To explore whether previous DMTs with lo...
Autores principales: | , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
BMJ Publishing Group
2022
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9304086/ https://www.ncbi.nlm.nih.gov/pubmed/35508373 http://dx.doi.org/10.1136/jnnp-2022-328797 |
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author | Kvistad, Silje Agnethe Stokke Burman, Joachim Lehmann, Anne Kristine Tolf, Andreas Zjukovskaja, Christina Melve, Guro Kristin Bø, Lars Torkildsen, Øivind |
author_facet | Kvistad, Silje Agnethe Stokke Burman, Joachim Lehmann, Anne Kristine Tolf, Andreas Zjukovskaja, Christina Melve, Guro Kristin Bø, Lars Torkildsen, Øivind |
author_sort | Kvistad, Silje Agnethe Stokke |
collection | PubMed |
description | BACKGROUND: Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective treatment for multiple sclerosis (MS). The impact of previous long-lasting disease-modifying treatments (DMT) for safety and efficacy of AHSCT is unknown. OBJECTIVE: To explore whether previous DMTs with long-lasting effects on the immune system (anti-CD20 therapy, alemtuzumab and cladribine) affect treatment-related complications, long-term outcome and risk of new MS disease activity in patients treated with AHSCT. METHODS: Retrospective observational study of 104 relapsing remitting patients with MS treated by AHSCT in Sweden and Norway from 2011 to 2021, grouped according to the last DMT used ≤6 months prior to AHSCT. The primary outcomes were early AHSCT-related complications (mortality, neutropenic fever and hospitalisation length), long-term complications (secondary autoimmunity) and proportion of patients with No Evidence of Disease Activity (NEDA-3 status): no new relapses, no MRI activity and no disease progression during the follow-up. RESULTS: The mean follow-up time was 39.5 months (range 1–95). Neutropenic fever was a common AHSCT-related complication affecting 69 (66%) patients. There was no treatment-related mortality. During the follow-up period, 20 patients (19%) were diagnosed with autoimmunity. Occurrence of neutropenic fever, hospitalisation length or secondary autoimmunity did not vary dependent on the last DMT used prior to AHSCT. A total of 84 patients (81%) achieved NEDA-3 status, including all patients (100%) using rituximab, alemtuzumab or cladribine before AHSCT. CONCLUSION: This study provides level 4 evidence that AHSCT in patients previously treated with alemtuzumab, cladribine or rituximab is safe and efficacious. |
format | Online Article Text |
id | pubmed-9304086 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2022 |
publisher | BMJ Publishing Group |
record_format | MEDLINE/PubMed |
spelling | pubmed-93040862022-08-11 Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT Kvistad, Silje Agnethe Stokke Burman, Joachim Lehmann, Anne Kristine Tolf, Andreas Zjukovskaja, Christina Melve, Guro Kristin Bø, Lars Torkildsen, Øivind J Neurol Neurosurg Psychiatry Multiple Sclerosis BACKGROUND: Autologous haematopoietic stem cell transplantation (AHSCT) is a highly effective treatment for multiple sclerosis (MS). The impact of previous long-lasting disease-modifying treatments (DMT) for safety and efficacy of AHSCT is unknown. OBJECTIVE: To explore whether previous DMTs with long-lasting effects on the immune system (anti-CD20 therapy, alemtuzumab and cladribine) affect treatment-related complications, long-term outcome and risk of new MS disease activity in patients treated with AHSCT. METHODS: Retrospective observational study of 104 relapsing remitting patients with MS treated by AHSCT in Sweden and Norway from 2011 to 2021, grouped according to the last DMT used ≤6 months prior to AHSCT. The primary outcomes were early AHSCT-related complications (mortality, neutropenic fever and hospitalisation length), long-term complications (secondary autoimmunity) and proportion of patients with No Evidence of Disease Activity (NEDA-3 status): no new relapses, no MRI activity and no disease progression during the follow-up. RESULTS: The mean follow-up time was 39.5 months (range 1–95). Neutropenic fever was a common AHSCT-related complication affecting 69 (66%) patients. There was no treatment-related mortality. During the follow-up period, 20 patients (19%) were diagnosed with autoimmunity. Occurrence of neutropenic fever, hospitalisation length or secondary autoimmunity did not vary dependent on the last DMT used prior to AHSCT. A total of 84 patients (81%) achieved NEDA-3 status, including all patients (100%) using rituximab, alemtuzumab or cladribine before AHSCT. CONCLUSION: This study provides level 4 evidence that AHSCT in patients previously treated with alemtuzumab, cladribine or rituximab is safe and efficacious. BMJ Publishing Group 2022-08 2022-05-04 /pmc/articles/PMC9304086/ /pubmed/35508373 http://dx.doi.org/10.1136/jnnp-2022-328797 Text en © Author(s) (or their employer(s)) 2022. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ. https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) . |
spellingShingle | Multiple Sclerosis Kvistad, Silje Agnethe Stokke Burman, Joachim Lehmann, Anne Kristine Tolf, Andreas Zjukovskaja, Christina Melve, Guro Kristin Bø, Lars Torkildsen, Øivind Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title | Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title_full | Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title_fullStr | Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title_full_unstemmed | Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title_short | Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT |
title_sort | impact of previous disease-modifying treatment on safety and efficacy in patients with ms treated with ahsct |
topic | Multiple Sclerosis |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9304086/ https://www.ncbi.nlm.nih.gov/pubmed/35508373 http://dx.doi.org/10.1136/jnnp-2022-328797 |
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