This has possibly been posted before but when I look for it I can only find outdated links etc, so forgive me if I am being redundant:
This is what JH sent to us:
High-Dose Cyclophosphamide for Moderate
to Severe Refractory Multiple Sclerosis
Douglas E. Gladstone, MD; Kenneth W. Zamkoff, MD; Lauren Krupp, MD; Robert Peyster, MD; Patrick Sibony, MD;
Christopher Christodoulou, PhD; Emily Locher, RN; Patricia K. Coyle, MD
Background: High-dose cyclophosphamide is active in
Objective: To describe the effects of high-dose cyclophosphamide
on severe refractory multiple sclerosis.
Design, Setting, and Patients: Patients with multiple
sclerosis with an Expanded Disability Status Scale
(EDSS) score of 3.5 or higher after 2 or more Food and
Drug Administration–approved disease-modifying therapy
regimens were evaluated.
Interventions: Patients received 200 mg/kg of cyclophosphamide
over 4 days.
Main Outcome Measures: Patients had brain magnetic
resonance imaging and neuro-ophthalmologic evaluations
every 6 months and quarterly EDSS and quality-
of-life evaluations for 2 years.
Results: Twelve patients were evaluated for clinical response
(median follow-up, 15.0 months; follow-up range,
6-24 months). During follow-up, no patients increased their
baseline EDSS scores by more than 1.0. Five patients decreased
their EDSS scores by 1.0 or more (EDSS score decrease
range, 1.0-5.0). No patient had a new lesion on brain
magnetic resonance imaging. No patient showed any enhancing
lesions. Patients reported improvement in all of
the quality-of-life parameters measured. Neurologic improvement
involved changes in gait, bladder control, and
visual function. Treatment response was seen regardless
of the baseline presence or absence of contrast lesion activity.
Patient quality-of-life improvement occurred independently
of EDSS score changes. In this small group of
patients with treatment-refractory multiple sclerosis, high-
dose cyclophosphamide was associated with minimal morbidity
and improved clinical outcomes.
Conclusions: High-dose cyclophosphamide treatment in
patients with severe refractory multiple sclerosis can result
in disease stabilization, improved functionality, and improved
quality of life. Further studies are necessary to determine
the most appropriate patients for this treatment.
Departments of Medicine
(Drs Gladstone and Zamkoff
and Ms Locher), Neurology
(Drs Krupp, Christodoulou,
and Coyle), Radiology
(Dr Peyster), and
Ophthalmology (Dr Sibony),
State University of New York at