Saturday, 17 June 2017

HSCT putting brain loss down to aging

Lee H, Nakamura K, Narayanan S, Brown R, Chen J, Atkins HL, Freedman MS, Arnold DL. Impact of immunoablation and autologous hematopoietic stem cell transplantation on gray and white matter atrophy in multiple sclerosis.Mult Scler. 2017 Jun 1:1352458517715811.

BACKGROUND:Immunoablation and autologous hematopoietic stem cell transplantation (HSCT) halts relapses, white matter (WM) lesion formation, and pathological whole-brain (WB) atrophy in multiple sclerosis (MS) patients. Whether the latter was due to effects on gray matter (GM) or WM warranted further exploration.
OBJECTIVE:To model GM and WM volume changes after HSCT to further understand the effects seen on WB atrophy.
METHODS: GM and WM volume changes were calculated from serial baseline and follow-up magnetic resonance imaging (MRI) ranging from 1.5 to 10.5 years in 19 MS patients treated with HSCT.
RESULTS: Accelerated short-term atrophy of 2.1% and 3.2% occurred in GM and WM, respectively, on average. Both busulfan dose and T1LV were significant predictors of WM atrophy, whereas only busulfan was a significant predictor of GM atrophy. Compared to baseline, a significant reduction in GM atrophy, not WM atrophy, was found. The average rates of long-term GM and WM atrophy were -0.18%/year (standard error (SE): 0.083) and -0.07%/year (SE: 0.14), respectively.
CONCLUSION:Chemotherapy-related toxicity affected both GM and WM. WM was further affected by focal T1-weighted lesion-related pathologies. Long-term rates of GM and WM atrophy were comparable to those of normal-aging.

This study  looks at the effect of HSCT on brain atrophy. There appears to be an initial problem of early brain volume lost and although this could be because of loss of inflammation but as profG showed many years ago the drugs used are neurotoxic and cause some nerve damage and this can be seen by neurofilaments (bits of nerves) being found. However with time it looks like brain volume lost is reduced to the level associated with normal aging. This has been seen with alemtuzumab.

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