Highlights
- •Brain volume declines after hematopoietic stem cell transplantation (HSCT) in MS.
- •Cognition declines in the initial period following HSCT.
- •The cognitive decline has little relationship to volume changes.
- •With temporal distance from HSCT, cognition returns to baseline levels.
- •Immunoablation and HSCT may have no lasting deleterious effects on cognition.
Abstract
Background
Individuals with MS undergoing immunoablative therapy and hematopoietic stem cell
transplantation (HSCT) show substantial decrease in brain volume over 2.4 months,
presumably from chemotoxic effects, although other mechanisms have also been postulated.
Objective
We examined whether volume loss was accompanied by a concomitant decrease in cognition.
White and gray matter volumes, and the effect of stem cell dosage were considered.
Methods
Seven individuals with rapidly progressing MS and poor prognosis underwent high dose
immunosuppression and autologous HSCT. Neuropsychological testing and MRI scans were
performed at baseline, 2 and 24 months post-procedure.
Results
Cognitive impairment was noted at all times in most participants. Median decline of
1.39% in total brain volume was noted 2 months post-HSCT. By 24 months a further decline
of 1.65% was noted. At 2 months significant decline was observed for areas of executive
functioning. At 24 months almost no significant declines were noted. No significant
correlations were found between cognitive decline and change in imaging variables
or stem cell dosage.
Conclusions
Cognition changed in the early period following treatment but with little apparent
relationship to volume changes. With temporal distance from the HSCT procedure, cognition
returned to baseline levels. With the caution of a very small sample, preliminary
results suggest that immunoablation and HSCT may have no lasting deleterious effects
on cognition.
Keywords
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Article info
Publication history
Published online: June 07, 2013
Accepted:
May 2,
2013
Received in revised form:
May 1,
2013
Received:
January 15,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
