Continued disease activity in a patient with multiple sclerosis after allogeneic hematopoietic cell transplantation.
OBJECTIVE
To examine the effect of allogeneic hematopoietic cell transplantation (HCT) on disease activity in a patient with multiple sclerosis (MS).


METHODS
Case report, prospective study, and autopsy.


METHODS
Departments of Clinical Neurosciences, Internal Medicine, and Pathology at the University of Calgary, Alberta, Canada.


METHODS
A 39-year-old woman with chronic myelogenous leukemia and concurrent mild MS.


METHODS
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.


CONCLUSIONS
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.
Lu
Jian-Qiang
JQ
Department of Pathology, Foothills Medical Centre, University of Calgary, 1403 29th St NW, Calgary, Alberta T2N 2T9, Canada.
Storek
Jan
J
Metz
Luanne
L
Yong
V Wee
VW
Stevens
Anne M
AM
Nash
Richard A
RA
Joseph
Jeffrey T
JT
D000257:Adenoviridae Infections / Q000276:immunology / Q000401:mortality; D000328:Adult; D002490:Central Nervous System / Q000276:immunology / Q000473:pathology / Q000503:physiopathology; D018450:Disease Progression; D017809:Fatal Outcome; D005260:Female; D006086:Graft vs Host Disease / Q000276:immunology; D018380:Hematopoietic Stem Cell Transplantation / Q000009:adverse effects*; D006525:Hepatitis, Viral, Human / Q000276:immunology / Q000401:mortality; D006801:Humans; D007108:Immune Tolerance / Q000276:immunology; D016867:Immunocompromised Host / Q000276:immunology; D015464:Leukemia, Myelogenous, Chronic, BCR-ABL Positive / Q000628:therapy; D008214:Lymphocytes / Q000276:immunology; D008279:Magnetic Resonance Imaging; D020529:Multiple Sclerosis, Relapsing-Remitting / Q000276:immunology* / Q000473:pathology*; D011446:Prospective Studies; D012008:Recurrence; D018183:Transplantation Chimera / Q000276:immunology; D023001:Transplantation Tolerance; D014184:Transplantation, Homologous