MRI and CSF oligoclonal bands after autologous hematopoietic stem cell transplantation in MS

Objective: To analyze the MRI and CSF oligoclonal bands (OB) changes in pat ients with MS who underwent an autologous hematopoietic stem cell transplan tation (AHSCT), Background: AHSCT is evaluated as an alternative therapy in severe MS. In previous series of AHSCT for MS, data on MRI or OB outcome w ere limited or not provided, Methods: Five patients with a median Kurtzke's EDSS score of 6.5, more than two attacks, and confirmed worsening of the E DSS in the previous year received an AHSCT. Hematopoietic stem cells were m obilized with cyclophosphamide (3 g/m2) and granulocyte colony-stimulating factor (5 mug/kg/d). The graft was T cell depleted by positive CD 34+ selec tion. Conditioning regimen included BCNU (300 mg/m(2)), cyclophosphamide (1 50 mg/kg in 3 days), and antihymocyte globulin (60 mg/kg in 4 days) MRI sca ns were scheduled at baseline and 1, 3, 6, and 12 months and OB analysis at baseline and 3 and 12 months post-AHSCT. Results: Four patients had a stab le or improved EDSS after a median follow-up of 18 months (range, 12 to 24 months). The fifth patient's condition deteriorated during AHSCT. She parti ally improved and remained stable after month 3 after AHSCT. The baseline C SF OB persisted 1 year after AHSCT, MRI studies after AHSCT showed no enhan ced T1 lesions and no new or enlarging T2 lesions. The median percentage ch ange of T2 lesion load was -11.8% (range, -26.6 to -4.0%). All patients had a decrease of corpus callosum area at 1 year (median, 12.4%; range, 7.8% t o 20.5%) that did not progress in the two patients evaluated at 2 years aft er AHSCT. Conclusions:,Although the persistence of CSF OB suggests the lymp hocytes were not eliminated from the CNS, tire follow-up MRI studies showed no enhanced T1 brain lesions and a reduction in the T2 lesion load that co rrelated with the clinical stabilization of MS after AHSCT.