Disease-modifying therapies (DMTs) for patients with multiple sclerosis (MS) is desirable in patients with highly active and aggressive MS and concurrent central nervous system (CNS) tumors, a new study published in Neurological Sciences suggests.
The clinical management of patients with simultaneous MS and CNS tumors is challenging due to several possible treatment limitations plus the intrinsic physical burden of both diseases. Studies have shown that DMTs could pose a threat for patients with MS because immunosuppression increases the risk of complications like infection.
The authors conducted a single-center retrospective cohort study assessing 16 patients with simultaneous MS and CNS tumors. They analyzed the demographic and clinical characteristics to determine a possible link between CNS tumor therapies and MS disease activity.
Notably, the study’s central question was how the treatment of each disease, chemotherapy for CNS tumors and DMT for MS, could aggravate each other. For example, DMT could enhance the immunosuppression caused by chemotherapy, increasing the risk of overall complications.
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On the other hand, withholding DMT from patients with MS could significantly threaten their quality of life and overall survival. Not treating active MS disease may result in neurological damage, adding to that already caused by the CNS tumor.
Half of the patients received chemotherapy, and 43.75% continued their DMT for MS after a CNS tumor diagnosis. The MS diagnosis was made before that of the CNS tumor by an average of 9 years, and 25% of patients discontinued DMT after a CNS tumor diagnosis. The authors noted that MS relapses primarily occurred in patients without previous chemotherapy treatment, and suggest that this may be due to the immunosuppressive effect of chemotherapy.
“These findings imply that chemotherapy employed for the treatment of CNS tumors reduces by far the need for additional DMT in concurrent MS and that there might not be a significant level of MS disease activity after chemotherapy,” they said. The longstanding effect of chemotherapy on the immune system may indicate that MS patients could only benefit from DMT if they do not undergo chemotherapy.
“Chemotherapy treatment might be associated with an unfavorable risk–benefit ratio of an additional DMT unless the patient has a highly active, very aggressive course of MS,” the authors concluded.
Nevertheless, the authors still encourage personal risk assessment as the best clinical approach for patients with MS with simultaneous CNS tumors. Further prospective studies with larger sample sizes that adjust for possible cofounders, like corticosteroid use, are needed.
Yalachkov Y, Dabanli D, Wenger KJ, Forster MT, Steinbach JP, Voss M. Concurrent CNS tumors and multiple sclerosis: retrospective single-center cohort study and lessons for the clinical management. Neurol Sci. Published online May 19, 2022. doi:10.1007/s10072-022-06142-4