Continued Disease Activity in a Patient With Multiple Sclerosis After Allogeneic Hematopoietic Cell Transplantation

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ObjectiveTo examine the effect of allogeneic hematopoietic cell transplantation (HCT) on disease activity in a patient with multiple sclerosis (MS).DesignCase report, prospective study, and autopsy.SettingDepartments of Clinical Neurosciences, Internal Medicine, and Pathology at the University of Calgary, Alberta, Canada.PatientA 39-year-old woman with chronic myelogenous leukemia and concurrent mild MS.InterventionsHematopoietic cell transplantation from a healthy unrelated donor.ResultsAfter HCT the patient developed graft-vs-host disease and experienced worsening, but not new, neurological symptoms. Her circulating leukocytes were 100% of donor origin. Magnetic resonance imaging showed increased lesion burden. She died of adenovirus hepatitis 20 weeks after HCT. An autopsy revealed demyelinating-inflammatory activity in active lesions and chronic active lesions.ConclusionDespite high-dose, cytotoxic, immunosuppressive therapy and exchange of a presumed autoreactive immune system with a healthy immune system, MS in this patient continued to be active.

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