aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis

Abstract Objective Autologous hematopoietic stem cell transplantation (aHSCT) is increasingly recognized as a potential therapy for patients with highly active multiple sclerosis (MS). This study aims to assess outcome differences in disease activity in MS patients treated either with aHSCT or alemt...

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Main Authors: Vivien Häußler, Friederike Ufer, Jana Pöttgen, Christine Wolschke, Manuel A. Friese, Nicolaus Kröger, Christoph Heesen, Jan‐Patrick Stellmann
Format: Article
Language:English
Published: Wiley 2021-06-01
Series:Annals of Clinical and Translational Neurology
Online Access:https://doi.org/10.1002/acn3.51366
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spelling doaj-96a40fa750014c9e84c1963b7b94bb742021-05-30T16:53:11ZengWileyAnnals of Clinical and Translational Neurology2328-95032021-06-01861269127810.1002/acn3.51366aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosisVivien Häußler0Friederike Ufer1Jana Pöttgen2Christine Wolschke3Manuel A. Friese4Nicolaus Kröger5Christoph Heesen6Jan‐Patrick Stellmann7Institute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyInstitute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyInstitute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyDepartment of Stem Cell Transplantation University Medical Center Hamburg‐Eppendorf Martinistraße 52 Hamburg20246GermanyInstitute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyDepartment of Stem Cell Transplantation University Medical Center Hamburg‐Eppendorf Martinistraße 52 Hamburg20246GermanyInstitute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyInstitute of Neuroimmunology and Multiple Sclerosis University Medical Centre Hamburg‐Eppendorf Falkenried 94 Hamburg20251GermanyAbstract Objective Autologous hematopoietic stem cell transplantation (aHSCT) is increasingly recognized as a potential therapy for patients with highly active multiple sclerosis (MS). This study aims to assess outcome differences in disease activity in MS patients treated either with aHSCT or alemtuzumab. Methods We conducted a monocentric registry‐based cohort study by recording the clinical course (EDSS and relapses), MRI parameters (new T2 lesions), and neuropsychological assessment in all 19 MS patients receiving aHSCT, and all 21 patients receiving alemtuzumab between 2007 and 2018. We used survival analyses of no evidence of disease activity (NEDA) as the primary objective which was defined by no EDSS progression, no relapse, and no new T2 lesion on MRI. Secondary objectives were EDSS improvement and neurocognitive performance. Results Both treatment groups were similar in respect of age, gender, disability, and neurocognitive performance except for significantly longer disease duration in the alemtuzumab group. Mean follow‐up was 58.8 [range 29–140] months in the aHSCT group compared to 27.6 [range 11–52] months in the alemtuzumab‐treated group. We observed significantly more patients maintaining NEDA in the aHSCT group (p = 0.048) compared to the alemtuzumab‐treated patients. Furthermore, 37% of the aHSCT patients showed an improvement of EDSS compared to none in the alemtuzumab‐treated group (p = 0.033). It is of note that cognitive function was significantly improved in the aHSCT‐treated patients. Interpretation aHSCT suppresses inflammatory activity more effectively than alemtuzumab and might enable improvement of overall disability and cognition in MS.https://doi.org/10.1002/acn3.51366
collection DOAJ
language English
format Article
sources DOAJ
author Vivien Häußler
Friederike Ufer
Jana Pöttgen
Christine Wolschke
Manuel A. Friese
Nicolaus Kröger
Christoph Heesen
Jan‐Patrick Stellmann
spellingShingle Vivien Häußler
Friederike Ufer
Jana Pöttgen
Christine Wolschke
Manuel A. Friese
Nicolaus Kröger
Christoph Heesen
Jan‐Patrick Stellmann
aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
Annals of Clinical and Translational Neurology
author_facet Vivien Häußler
Friederike Ufer
Jana Pöttgen
Christine Wolschke
Manuel A. Friese
Nicolaus Kröger
Christoph Heesen
Jan‐Patrick Stellmann
author_sort Vivien Häußler
title aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
title_short aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
title_full aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
title_fullStr aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
title_full_unstemmed aHSCT is superior to alemtuzumab in maintaining NEDA and improving cognition in multiple sclerosis
title_sort ahsct is superior to alemtuzumab in maintaining neda and improving cognition in multiple sclerosis
publisher Wiley
series Annals of Clinical and Translational Neurology
issn 2328-9503
publishDate 2021-06-01
description Abstract Objective Autologous hematopoietic stem cell transplantation (aHSCT) is increasingly recognized as a potential therapy for patients with highly active multiple sclerosis (MS). This study aims to assess outcome differences in disease activity in MS patients treated either with aHSCT or alemtuzumab. Methods We conducted a monocentric registry‐based cohort study by recording the clinical course (EDSS and relapses), MRI parameters (new T2 lesions), and neuropsychological assessment in all 19 MS patients receiving aHSCT, and all 21 patients receiving alemtuzumab between 2007 and 2018. We used survival analyses of no evidence of disease activity (NEDA) as the primary objective which was defined by no EDSS progression, no relapse, and no new T2 lesion on MRI. Secondary objectives were EDSS improvement and neurocognitive performance. Results Both treatment groups were similar in respect of age, gender, disability, and neurocognitive performance except for significantly longer disease duration in the alemtuzumab group. Mean follow‐up was 58.8 [range 29–140] months in the aHSCT group compared to 27.6 [range 11–52] months in the alemtuzumab‐treated group. We observed significantly more patients maintaining NEDA in the aHSCT group (p = 0.048) compared to the alemtuzumab‐treated patients. Furthermore, 37% of the aHSCT patients showed an improvement of EDSS compared to none in the alemtuzumab‐treated group (p = 0.033). It is of note that cognitive function was significantly improved in the aHSCT‐treated patients. Interpretation aHSCT suppresses inflammatory activity more effectively than alemtuzumab and might enable improvement of overall disability and cognition in MS.
url https://doi.org/10.1002/acn3.51366
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