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Abstract Details

Multiple sclerosis-like CNS inflammation following allogeneic haematopoietic stem cell transplantation treated with a ‘domino’ autologous haematopoietic stem cell transplantation
Multiple Sclerosis
P6 - Poster Session 6 (12:00 PM-1:00 PM)
9-015
Complications involving the central nervous system (CNS) occur in 9-14% of patients following allogeneic haematopoietic stem cell transplantation (HSCT), including stroke-like episodes, demyelination, encephalitis and nonspecific neurological symptoms.

To report the first patient with multiple sclerosis (MS) like neuroinflammation following allogeneic haematopoietic stem cell transplantation (HSCT), who was treated with a ‘domino’ autologous HSCT.

n/a

A 53-year-old male was treated with allogeneic HSCT for lymphoid blast transformation of chronic myeloid leukaemia.  Ten months later he presented with confusion, slurred speech, left sided facial weakness and ataxia.  He had no systemic features suggestive of graft versus host disease, such as rash, deranged liver function or gastrointestinal disturbance.  MRI brain scan showed multiple enhancing tumefactive lesions.  After extensive investigations for infections and recurrence of malignancy, he underwent brain biopsy, which showed demyelination.  Although symptoms improved with corticosteroids, relapse occurred after five months and he was diagnosed with MS.  The disease followed an aggressive course and did not respond to glatiramer acetate and natalizumab.  His EDSS score reached 8 within 2 years from the first presentation of neuroinflammation.  The patient was treated with a ‘domino’ autologous HSCT, where the patient, a recipient of previous allogeneic transplant serving as a ‘donor’ for his second transplant.  It produced a transient response but failed to induce long-term disease remission.  He was treatment with ocrelizumab, but he died of progressive disease 4 months later.

This was a unique case for two reasons.  Firstly, this patient had clinical and radiological features consistent with MS-like CNS demyelinating disorder in the absence of systemic graft versus host disease following allogenic HSCT.  Secondly, this patient experienced an ‘aggressive’ form of disease, which failed to respond to standard disease modifying therapies for MS resulting in treatment with ‘domino’ autologous HSCT.  Neither of these were reported in the literature. 
Authors/Disclosures
Joyutpal Das, MBBS
PRESENTER
Dr. Das has nothing to disclose.
Atta Gill No disclosure on file
Christine Jiaying Lo, MD (Royal Hallamshire Hospital) No disclosure on file
Natalie Chan-Lam No disclosure on file
Sian Price No disclosure on file
Stephen Wharton No disclosure on file
Helen Jessop No disclosure on file
Basil Sharrack, MD, PhD, FAAN (Department of Neuroscience) Dr. Sharrack has nothing to disclose.
John Snowden No disclosure on file