Archives of neurology · 2009
Continued disease activity in a patient with multiple sclerosis after allogeneic hematopoietic cell transplantation.
Клинический случайСтатьяПоддержка исследования: вне правительства СШАНазвание и аннотация: Перевод пока не подготовлен
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Lu Jian-Qiang, Storek Jan, Metz Luanne, Yong V Wee, Stevens Anne M, Nash Richard A, Joseph Jeffrey T
Аннотация
OBJECTIVE: To examine the effect of allogeneic hematopoietic cell transplantation (HCT) on disease activity in a patient with multiple sclerosis (MS).
DESIGN: Case report, prospective study, and autopsy.
SETTING: Departments of Clinical Neurosciences, Internal Medicine, and Pathology at the University of Calgary, Alberta, Canada.
PATIENT: A 39-year-old woman with chronic myelogenous leukemia and concurrent mild MS.
INTERVENTIONS: Hematopoietic cell transplantation from a healthy unrelated donor.
RESULTS: After 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.
CONCLUSION: Despite 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.
DESIGN: Case report, prospective study, and autopsy.
SETTING: Departments of Clinical Neurosciences, Internal Medicine, and Pathology at the University of Calgary, Alberta, Canada.
PATIENT: A 39-year-old woman with chronic myelogenous leukemia and concurrent mild MS.
INTERVENTIONS: Hematopoietic cell transplantation from a healthy unrelated donor.
RESULTS: After 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.
CONCLUSION: Despite 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.
Предметные рубрики MeSH
Adenoviridae InfectionsAdultCentral Nervous SystemDisease ProgressionFatal OutcomeFemaleGraft vs Host DiseaseHematopoietic Stem Cell TransplantationHepatitis, Viral, HumanHumansImmune ToleranceImmunocompromised HostLeukemia, Myelogenous, Chronic, BCR-ABL PositiveLymphocytesMagnetic Resonance ImagingMultiple Sclerosis, Relapsing-RemittingProspective StudiesRecurrenceTransplantation ChimeraTransplantation ToleranceTransplantation, Homologous