A Three-Year Study of Brain Atrophy after Autologous Hematopoietic Stem Cell Transplantation in Rapidly Evolving Secondary Progressive Multiple Sclerosis

BRAIN

M.A. Rocca^a, T. Mondria^c, P. Valsasina^a, M.P. Sormani^a,f, Z.H. Flach^d, P.A. Te Boekhorst^e, G. Comi^b, R.Q. Hintzen^c and M. Filippi^a,b

^a Neuroimaging Research Unit, Scientific Institute and University San Raffaele, Milan, Italy
^b Department of Neurology, Scientific Institute and University San Raffaele, Milan, Italy
^c Department of Neurology, Erasmus Medical Center, Rotterdam, the Netherlands
^d Department of Radiology, Erasmus Medical Center, Rotterdam, the Netherlands
^e Department of Haematology, Erasmus Medical Center, Rotterdam, the Netherlands
^f Biostatistics Unit, Department of Health Sciences, University of Genoa, Genoa, Italy

Please address correspondence to Massimo Filippi, Neuroimaging Research Unit, Department of Neurology, San Raffaele Scientific Institute, via Olgettina 60, 20132 Milan, Italy; e-mail: filippi.massimo@hsr.it

BACKGROUND AND PURPOSE: In multiple sclerosis (MS), autologous hematopoietic stem cell transplantation (AHSCT) induces a profound suppression of clinical activity and MR imaging-detectable inflammation, but it may be associated with a rapid brain volume loss in the months subsequent to treatment. The aim of this study was to assess how AHSCT affects medium-term evolution of brain atrophy in MS.

MATERIALS AND METHODS: MR imaging scans of the brain from 14 patients with rapidly evolving secondary-progressive MS obtained 3 months before and every year after AHSCT for 3 years were analyzed. Baseline normalized brain volumes and longitudinal percentage of brain volume changes (PBVCs) were assessed using the Structural Image Evaluation of Normalized Atrophy software.

RESULTS: The median decrease of brain volume was 1.92% over the first year after AHSCT and then declined to 1.35% at the second year and to 0.69% at the third year. The number of enhancing lesions seen on the pretreatment scans was significantly correlated with the PBVCs between baseline and month 12 (r = –0.62; P = .02); no correlation was found with the PBVCs measured over the second and third years.

CONCLUSIONS: After AHSCT, the rate of brain tissue loss in patients with MS declines dramatically after the first 2 years. The initial rapid development of brain atrophy may be a late consequence of the pretransplant disease activity and/or a transient result of the intense immunoablative conditioning procedure.
http://www.ajnr.org/cgi/content/abstract/28/9/1659