This Is MS Multiple Sclerosis Community: Knowledge & Support

I found this one specially interesting because previous studies on autologous stem cell transplants showd a significant increase in brain atrophy. Possible due to the toxic effect of chemo-therapy which would also be relevant for HDC treatment.

--Frank


Short-term exposure to cyclophosphamide is effective in reducing long-term brain atrophy in refractory relapsing-remitting multiple sclerosis
J. Perumal, F. Bao, Z. Latif, I. Zak, C. Caon, A. Tselis, O. Khan (Detroit, USA)
________________________________________

Objective:
To investigate the effect of immunosuppression with cyclophosphamide (CTX) in reducing brain atrophy in refractory RRMS not responsing to interferon beta (IFNB) or glatiramer acetate (GA).
Background: Immunosuppression with CTX is often used as a therapeutic intervention in refractory RRMS not responding to therapy with IFNB or GA. Previous studies have identified young age and clinically active disease as two important factors in predicting a favorable response to CTX. It is unclear if treatment with CTX has a long-term effect on reducing brain atrophy.

Methods:
We treated 31 RRMS patients with intravenous CTX who failed therapy with IFNB or GA defined as two relapses in the prior year despite therapy. Brain MRI scans were obtained prior to IV CTX which was given monthly for 6 months at a dose of 1000 mg/m2 of BSA. Doses of CTX were adjusted to achieve a two-week WBC nadir of 2000 to 2500. All patients resumed therapy with IFNB or GA after 6 months. In 4 cases, IV CTX was continued on alternate months for an additional 6 months. Brain MRI scans with an identical protocol were obtained 3 years after stopping CTX. Patients were examined every 3 to 6 months during this period. 40 RRMS patients who received either IFNB or GA with monthly steroids for 6 to 12 months and declined treatment with CTX were also imaged over a 3 year period avoiding MRI scans within 6 weeks of steroid administration. 12 healthy volunteers were also imaged to check reproducibility of imaging technique.

Results:
Using SIENAX, cross sectional normalized brain volume was 1512.4 + 76 ml in the CTX-treated group and 1487.4 + 86 ml in the non-CTX treated group. Percent change measured with SIENA versus baseline scan was -1.3% in the CTX-treated group and -2.7 % in the non-CTX treated group (p<0.01). High lesion load at baseline showed a trend in correlating with brain volume change.

Conclusions:
Short-term exposure to intense immunosuppression with CTX may lead to long-term reduction of brain atrophy. Long-term studies may provide the best opportunity to study loss of brain volume.

_________________
Treatment: CCSVI both IJV ballooned 09/2010, No DMDs, Tysabri on hold after 24 Infusions, after LDN, ABX Wheldon Regime for 1 year.

Thanks Frank.

I was trying to look this up in pubmed to find a date and I can't find it.

I should have gotten with you earlier, but do you remember the source and how recent this is?

Bob

Hi Bob,

its from ECTRIMS 2007. You can find the abstract
here.

--Frank

_________________
Treatment: CCSVI both IJV ballooned 09/2010, No DMDs, Tysabri on hold after 24 Infusions, after LDN, ABX Wheldon Regime for 1 year.

Thank you Frank! I was hoping I could find more information, but I guess that's all they're going to give us for now
Bob