Treatment with autologous hematopoietic stem cell transplantation (AHSCT) in patients with multiple sclerosis (MS) who were previously treated with rituximab, alemtuzumab, or cladribine resulted in similar frequencies of adverse events as patients who previously received other disease-modifying therapies (DMTs), according to a new study published in the Journal of Neurology, Neurosurgery, & Psychiatry.
The researchers also found that 81% of patients enrolled achieved No Evidence of Disease Activity (NEDA-3) status including 100% of the patients who had received long-lasting DMTs prior to AHSCT.
Before this study, it was unknown whether AHSCT would be safe and effective in patients with MS who received prior treatment with DMTs that resulted in long-term effects on the immune system. These patients have been excluded in many studies due to concern over the potential for prolonged aplasia, risk of infections, and the development of secondary autoimmune diseases.
“In the upcoming years, a higher proportion of AHSCT patient candidates will have a medical history of prior usage of such DMTs. Our data indicate that previous treatment with alemtuzumab, cladribine or rituximab is safe, and associated with a high likelihood of sustained NEDA-3 after transplantation,” the authors said.
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Neutropenic fever occurred in 66% of patients but there was no significant difference between different DMTs (P =.3). The mean inpatient stay was 13 days and all patients were discharged within 23 days.
The follow-up period after AHSCT ranged from 1 to 95 months with a mean of 39.5 months. During this period, 20 patients (19%) developed secondary autoimmune diseases including hyperthyroidism (n=11), hypothyroidism (n=7), hypothyroidism with psoriasis vulgaris (n=1), and autoimmune thrombocytopenia purpura (n=1).
A total of 104 Swedish or Norwegian patients with relapsing-remitting MS were recruited for the study. The mean annual relapse rate for the year prior to AHSCT was 1.7 and most patients had a history of suboptimal response to DMTs. The mean number of previous DMTs was 2.1 but 17 patients had received ≥4 previous DMTS and 12 patients had received no previous MS treatment. Twenty-six patients had previously received either rituximab (n=18), alemtuzumab (n=6), or cladribine (n=2).
Kvistad SAS, Burman J, Lehmann AK, et al. Impact of previous disease-modifying treatment on safety and efficacy in patients with MS treated with AHSCT. J Neurol Neurosurg Psychiatry. Published online May 4, 2022. doi:10.1136/jnnp-2022-328797